Consumer use of the Internet for insomnia information

Abstract

Introduction Initiating various self-help strategies whilst delaying professional help-seeking is a common phenomenon reported among patients with insomnia. Clearly, patients with insomnia have avenues of seeking help outside the conventional health professional channels. One of these avenues may include the Internet. The Internet has been recognised as a cost-effective means of disseminating health information to a wide patient audience who are otherwise not reached through conventional modes of health care delivery. Thus, the Internet is an easily accessible health information resource for people with insomnia, especially as this help is available 24 hours a day. The utilisation of the Internet has been recognised within insomnia research, both as a causative risk for those using it into the early hours of the night, or as a medium to deliver interventions. However, little research has been published concerning the use of the Internet as a source of information about insomnia by Australian consumers. Although the Internet offers a convenient, accessible, and private source of information to those with a health problem, the diversity and variability of information available online can make consumers with limited training in health information retrieval especially susceptible to accessing information with questionable integrity. Based on the premise of Spielman’s 3Ps model (predisposition, precipitants, and perpetuation), adopting non-evidence–based sleep-promoting strategies (e.g. drinking alcohol) gleaned from, for example, the Internet, could potentially contribute to the development of maladaptive behaviors that perpetuate insomnia rather than resolve it. Poorly managed insomnia poses a significant burden on society through increased health-care expenditure and reduced workplace productivity. Despite these potential implications, little is known about the accuracy of the information about insomnia that is retrieved or how the consumers utilise this information. Thus, consumers’ online behaviour, experiences and preferences, as well as the effects of and the problems associated with online information about insomnia need to be evaluated. Exploring consumers’ health information-seeking patterns and behaviors on the Internet may also provide insight into their health-care needs and illuminate some of the upstream issues that may affect health information seeking in this insomnia patient group. Therefore, the overarching aim of this study was to explore consumer use of the Internet for accessing information about insomnia. We primarily focussed on the social, health and sleep demography of insomnia patients who used the Internet and explored patterns of information seeking as well as the implications of this use. Methods An online survey about sleep health information seeking on the Internet was circulated to Australian consumers registered on the database of a commercial market research company (online panel). The questionnaire was comprised of seven sections containing 65 questions related to demographics, medical history and lifestyle. Included in the questionnaire were also two validated instruments including: the Insomnia Severity Index (ISI), and the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16). The questionnaire queried general patterns of seeking information and help for sleep problems, and specifically queried health information seeking patterns on the Internet. Inclusion criteria for this study mandated that participants: be ≥ 18 years of age; with adequate English comprehension; be experiencing insomnia or insomnia symptoms and; have used the Internet. Sampling continued until at least 1000 complete responses were obtained. Results 1013 participants completed the questionnaire. Equal numbers of male and female subjects participated (mean age: 45.0 ± 16.0 years). A majority of participants were middle aged, married, eastern state residents with subclinical levels of insomnia and marked levels of dysfunctional beliefs. The Mean ISI score was 12.33 (SD ± 4.0) and the mean DBAS-16 score was 5.8 (SD ± 1.5). Only a third of the participants had consulted a physician for their sleep problems. The ‘physician’ was ranked first as a preferred source of health information by participants followed closely by the ‘Internet’ in second place. Most of the participants were frequent Internet users who mainly used Google for searching health information. Information of interest revolved around insomnia treatment options and symptomology. All participants accessed fewer than 10 websites for a given search and less than one quarter of participants (21%) discussed online information with their healthcare provider. However, 80% of participants’ decisions about seeking medical help and/or medication use were influenced by this information. In the logistic regression analysis, having a higher score in DBAS 16 questionnaire (e.g. having a high level of beliefs about sleep that are detrimental to sleep health) and medication for insomnia were identified as significant predictors for insomnia-related Internet use. Conclusion To the best of our knowledge, this is the first study to exclusively explore insomnia- related Internet search patterns of consumers in Australia. Therefore, this study represents an important step forward for optimising insomnia information on the Internet. Given that the Internet has become a widely used tool for sourcing information about health, this study can guide professional experts to structure key sleep health messages for the public. Knowing the profile of consumers who access the Internet for information about insomnia can also help insomnia experts to shape content that is targeted and helpful for information seekers. A knowledge of ‘who’ uses the Internet to search for information about insomnia and ‘what’ sites have been accessed may be helpful in understanding the health beliefs and expectations of consumers and in targeting health-related information. This study can help inform the design of websites with information about insomnia because it demonstrates what topics are frequently searched for, what search terms are used and the difficulties consumers have with using the Internet. Finally, consumers who took medications for insomnia were half as likely to look for insomnia information on the Internet than those who did not take medication for insomnia. Clearly, when prescribed a medication by a physician or recommended one by a pharmacist, there is sufficient detail about the medication provided to satiate the need for information. Mostly, it is expected that the detailed counselling is more a role of the pharmacists, given time pressures on primary care physicians. This implies that though pharmacists were not listed as one of the top ranked sources of information about insomnia; in practice, they are possibly providing adequate information and counselling with regards to insomnia treatment to those asking for insomnia medications. To conclude, the Internet does represent an important health-care portal for insomnia patients and warrants further investigation as targeted e-health interventions become more prominent in the routine management of insomnia.