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Objective: The author studied health information available for veterinary consumers both in print and online., Methods: WorldCat was searched using a list of fifty-three Library of Congress subject headings relevant to veterinary consumer health to identify print resources for review. Identified items were then collected and assessed for authority, comprehensiveness of coverage, validity, and other criteria outlined by Rees. An in-depth assessment of the information available for feline lower urinary tract disease (FLUTD) and canine congestive heart failure (CHF) was then conducted to examine the availability and quality of information available for specific diseases and disorders. A reading grade level was assigned for each passage using the Flesch-Kincaid formula in the Readability Statistics feature in Microsoft Word., Results/discussion: A total of 187 books and 7 Websites were identified and evaluated. More than half of the passages relating to FLUTD and CHF were written above an 11th-grade reading level. A limited quantity of quality, in-depth resources that address specific diseases and disorders and are written at an appropriate reading level for consumers is available., Conclusion: The library's role is to facilitate access to the limited number of quality consumer health resources that are available to veterinary consumers.

Current reports in the medical literature demonstrate increasing acknowledgment of consumer involvement in autonomous health and medical information search beyond the doctor. Although multiple studies have segmented consumers into different groups based on the different levels of patient autonomy, the literature review revealed the lack of systematic attempts at elucidating the antecedents of autonomous consumer health information search. In this article, I examine the role of health consciousness as a mediator of the relation between communicative (interpersonal, community, print, television, and Internet) factors and health information seeking.

Background: Many consumers use the Internet to find information about their medicines. It is widely acknowledged that health information on the Internet is of variable quality and therefore the search and appraisal skills of consumers are important for selecting and assessing this information. The way consumers choose and evaluate information on medicines on the Internet is important because it has been shown that written information on medicines can influence consumer attitudes to and use of medicines., Objective: To explore consumer experiences in searching for and appraising Internet-based information on medicines., Methods: Six focus groups (N = 46 participants) were conducted in metropolitan Sydney, Australia from March to May 2003 with consumers who had used the Internet for information on medicines. Verbatim transcripts of the group discussions were analyzed using a grounded theory approach., Results: All participants reported using a search engine to find information on medicines. Choice of search engine was determined by factors such as the workplace or educational environments, or suggestions by family or friends. Some participants found information solely by typing the medicine name (drug or brand name) into the search engine, while others searched using broader terms. Search skills ranged widely from more-advanced (using quotation marks and phrases) to less-than-optimal (such as typing in questions and full sentences). Many participants selected information from the first page of search results by looking for keywords and descriptions in the search results, and by looking for the source of the information as apparent in the URL. Opinions on credible sources of information on medicines varied with some participants regarding information by pharmaceutical companies as the "official" information on a medicine, and others preferring what they considered to be impartial sources such as governments, organizations, and educational institutions. It was clear that although most participants were skeptical of trusting information on the Internet, they had not paid conscious attention to how they selected information on medicines. Despite this, it was evident that participants viewed the Internet as an important source for information on medicines., Conclusions: The results showed that there was a range of search and appraisal skills among participants, with many reporting a limited awareness of how they found and evaluated Internet-based information on medicines. Poor interpretation of written information on medicines has been shown to lead to anxiety and poor compliance to therapy. This issue is more important for Internet-based information since it is not subject to quality control and standardization as is written information on medicines. Therefore, there is a need for promoting consumer search and appraisal skills when using this information. Educating consumers in how to find and interpret Internet-based information on medicines may help them use their medicines in a safer and more-effective way.

The end of the 20th century saw a sea of change in the view of individuals in relation to their health and health care. The term "consumer" began to be used to describe myriad new roles and responsibilities for lay people who receive health services and who are often the target of health promotion and disease prevention interventions. This article (1) describes how the term "consumer" is used by various stakeholders in the health care sector; (2) specifies the assumptions that underlie the notion that a "new" kind of health care consumer can (and should) have a significant effect on their own health and on the health care system; (3) challenges the evidence base of these assumptions, noting that many are either unsupported or clearly contradicted by what we know; (4) articulates a set of principles to inform an alternative, more productive, and feasible role for individuals with respect to their health and health care; and (5) identifies the implications of those principles for health promotion and health care professionals in the 21st century.

Increasingly, consumers engage in health information seeking via the Internet. Taking a communication perspective, this review argues why public health professionals should be concerned about the topic, considers potential benefits, synthesizes quality concerns, identifies criteria for evaluating online health information and critiques the literature. More than 70 000 websites disseminate health information; in excess of 50 million people seek health information online, with likely consequences for the health care system. The Internet offers widespread access to health information, and the advantages of interactivity, information tailoring and anonymity. However, access is inequitable and use is hindered further by navigational challenges due to numerous design features (e.g. disorganization, technical language and lack of permanence). Increasingly, critics question the quality of online health information; limited research indicates that much is inaccurate. Meager information-evaluation skills add to consumers' vulnerability, and reinforce the need for quality standards and widespread criteria for evaluating health information. Extant literature can be characterized as speculative, comprised of basic 'how to' presentations, with little empirical research. Future research needs to address the Internet as part of the larger health communication system and take advantage of incorporating extant communication concepts. Not only should research focus on the 'net-gap' and information quality, it also should address the inherently communicative and transactional quality of Internet use. Both interpersonal and mass communication concepts open avenues for investigation and understanding the influence of the Internet on health beliefs and behaviors, health care, medical outcomes, and the health care system.

Using data from an evaluation of a community-wide informational intervention, we modeled the demand for medical reference books, telephone advice nurses, and computers for health information. Data were gathered from random household surveys in Boise, ID (experimental site), Billings, MT, and Eugene, OR (control sites). Conditional difference-in-differences show that the intervention increased the use of medical reference books, advice nurses, and computers for health information by approximately 15, 6, and 4%. respectively. The results also suggest that the intervention was associated with a decreased reliance on health professionals for information.

Objective: The number of medical Web sites has increased tremendously during the past 5 years. While the quality of the content has also been on the rise, some questions are still open: Where are users referredfrom, how large is the target audience, and how do they behave during their visit?, Methods: The Asthma Information Center is an independent Web site for physicians, patients, and other health care professionals providing information about asthma. Besides mirroring electronic documents of the Global InitiativeforAsthma, numerous interactive pages have been constructed., Main Outcome Measures: Logfiles of the Web server were analyzed for a 5-year interval for numbers of page views, visitors, visits, and external referring sites., Results: The number of visitors has increased since 1995, up to 100,000 page views at the end of the observation interval. In February 2000 approximately 9000 visitors were recorded per month. 3.4 pages were retrieved per visit, which lasted on average 1:57 min. Users are referred primarily by portal sites and only to a lesser extent by search engines., Conclusions: The audience is large for a specialized medical Web site. Users are usually referred from nonmedical sites. They are seeking fast information, most probably as a second opinion after having consulted their physician.

Context: Information about the performance of hospitals, health professionals, and health care organizations has been made public in the United States for more than a decade. The expected gains of public disclosure have not been made clear, and both the benefits and potential risks have received minimal empirical investigation., Objective: To summarize the empirical evidence concerning public disclosure of performance data, relate the results to the potential gains, and identify areas requiring further research., Data Sources: A literature search was conducted on MEDLINE and EMBASE databases for articles published between January 1986 and October 1999 in peer-reviewed journals. Review of citations, public documents, and expert advice was conducted to identify studies not found in the electronic databases., Study Selection: Descriptive, observational, or experimental evaluations of US reporting systems were selected for inclusion., Data Extraction: Included studies were organized based on use of public data by consumers, purchasers, physicians, and hospitals; impact on quality of care outcomes; and costs., Data Synthesis: Seven US reporting systems have been the subject of published empirical evaluations. Descriptive and observational methods predominate. Consumers and purchasers rarely search out the information and do not understand or trust it; it has a small, although increasing, impact on their decision making. Physicians are skeptical about such data and only a small proportion makes use of it. Hospitals appear to be most responsive to the data. In a limited number of studies, the publication of performance data has been associated with an improvement in health outcomes., Conclusions: There are several potential gains from the public disclosure of performance data, but use of the information by provider organizations for quality improvement may be the most productive area for further research.

Context: Publicly released performance reports ("report cards") are expected to foster competition on the basis of quality. Proponents frequently cite the need to inform patient choice of physicians and hospitals as a central element of this strategy., Objective: To examine the awareness and use of a statewide consumer guide that provides risk-adjusted, in-hospital mortality ratings of hospitals that provide cardiac surgery., Design: Telephone survey conducted in 1996., Setting: Pennsylvania, where since 1992, the Pennsylvania Consumer Guide to Coronary Artery Bypass Graft [CABG] Surgery has provided risk-adjusted mortality ratings of all cardiac surgeons and hospitals in the state., Participants: A total of 474 (70%) of 673 eligible patients who had undergone CABG surgery during the previous year at 1 of 4 hospitals listed in the Consumer Guide as having average mortality rates between 1% and 5% were successfully contacted., Main Outcome Measures: Patients' awareness of the Consumer Guide, their knowledge of its ratings, their degree of interest in the report, and barriers to its use., Results: Ninety-three patients (20%) were aware of the Consumer Guide, but only 56 (12%) knew about it before surgery. Among these 56 patients, 18 reported knowing the hospital rating and 7 reported knowing the surgeon rating, 11 said hospital and/or surgeon ratings had a moderate or major impact on their decision making, but only 4 were able to specify either or both correctly. When the Consumer Guide was described to all patients, 264 (56%) were "very" or "somewhat" interested in seeing a copy, and 273 (58%) reported that they probably or definitely would change surgeons if they learned that their surgeon had a higher than expected mortality rate in the previous year. A short time window for decision making and a limited awareness of alternative hospitals within a reasonable distance of home were identified as important barriers to use., Conclusions: Only 12% of patients surveyed reported awareness of a prominent report on cardiac surgery mortality before undergoing cardiac surgery. Fewer than 1% knew the correct rating of their surgeon or hospital and reported that it had a moderate or major impact on their selection of provider. Efforts to aid patient decision making with performance reports are unlikely to succeed without a tailored and intensive program for dissemination and patient education.

With competition for enrollees reaching a fever pitch among health plans, calls are coming from many quarters for a reinvention of healthcare to focus on patients. That's producing a flood of information intended to help consumers compare plans and providers. What will consumers do with all the information? Will they understand it and use it?

Focus groups and in-depth telephone interviews were used to develop a telephone questionnaire later completed by people 55 years and older about their use of a Health Information Support Telephone Service (HISTS). Preliminary findings identified an equal number of well educated male and female callers, who called for information for themselves. The confidentially of the service was very important to respondents and may have impacted the time to recruit people for the focus groups. The second study described is a pilot test completed by three Consumer Health Information/Resource Centres (CHIRC). An Info Script was used by health professionals to direct people to information centres. Preliminary results indicate that over half of the participants stated they visited the information centre because they were given an Info Script and that they would not have gone without the Info Script.

This manuscript presents the results of a primary research study conducted among the elderly to determine the sources of information they prefer for the selection of dental services. The results of the study are presented in terms of source preferences by dental need (generalist or specialist), source preferences by gender (male or female), source preferences by level of education (low or high), and source preferences by income level (low or high). Conclusions are drawn from the results of the research, and suggestions are made regarding the use of information source preferences for the marketing of dental services to the elderly.

A national survey conducted in 1995 found that a disturbingly high percentage of Americans do not understand the basic elements of health plans and that people want much more information, particularly about the physicians in the plans and the range of services that are covered. Their most important concern when selecting a health plan is the quality of physicians in the plan, followed by the courtesy of doctors and staff and the freedom to choose their own doctors and hospitals.

The premise that competition will improve health care assumes that consumers will choose plans that best fit their needs and resources. However, many consumers are frustrated with currently available plan comparison information. We describe results from 22 focus groups in which Medicare beneficiaries, Medicaid enrollees, and privately insured consumers assessed the usefulness of indicators based on consumer survey data and Health Employer Data Information Set (HEDIS)-type measures of quality of care. Considerable education would be required before consumers could interpret report card data to inform plan choices. Policy implications for design and provision of plan information for Medicare beneficiaries and Medicaid enrollees are discussed.

The health care environment of the 1990s demands that hospital libraries develop creative strategies for providing consumer health information (CHI). Librarians at the Reuben L. Sharp Health Sciences Library at Cooper Hospital/University Medical Center have developed a multifaceted approach to the problem. Using a combination of institutional resources, private funding, and cooperative arrangements with public libraries, the Sharp Library helps to serve the consumer health information needs of the southern New Jersey community.

Considerable efforts are underway in the public and private sectors to increase the amount of information available to consumers when making health plan choices. The objective of this study was to examine the role of information in consumer health plan decisionmaking. A computer system was developed which provides different plan descriptions with the option of accessing varying types and levels of information. The system tracked the information search processes and recorded the hypothetical plan choices of 202 subjects. Results are reported showing the relationship between information and problem perception, preference structure, choice of plan, and attitude towards the decision.

This study explores consumers' comprehension of quality indicators appearing in health care report cards. Content analyses of focus group transcripts show differences in understanding individual quality indicators and among three populations: privately insured; Medicaid; and uninsured. Several rounds of coding and analysis assess: the degree of comprehension; what important ideas are not understood; and what exactly is not understood about the indicator (inter-rater reliability exceeded 94 percent). Thus, this study is an educational diagnosis of the comprehension of currently disseminated quality indicators. Fifteen focus groups (5 per insurance type) were conducted with a total of 104 participants. Findings show that consumers with differing access to and experiences with care have different levels of comprehension. Indicators are not well understood and are interpreted in unintended ways. Implications and strategies for communicating and disseminating quality information are discussed.

There is increased emphasis on improving the quality of health care by obtaining and disseminating information about the effectiveness and outcomes of care and by facilitating more consumer input participation in decision-making. We examine barriers to information use and the challenges that these barriers pose for effectiveness research. We divide our discussion into four goals of effectiveness research. These are: (1) to provide more information so that consumers, providers and policymakers can make "rational" decisions; (2) to incorporate patient preferences into health care decisions; (3) to develop guidelines that incorporate both individual perspectives and societal perspectives; (4) to use information to improve the practice of health care. We discuss four recommendations for improving the use of information: (1) the evidence on how people actually make decisions should be used to inform the design and implementation of effectiveness research; (2) decision-making should be structured through guidelines and policies; (3) criteria should be developed for determining which guidelines should fully incorporate patient preferences; (4) safeguards should be established to guard against misuse of information.

The behavioral patterns of the elderly population as they relate to the process of obtaining information on services such as health care are not currently well understood. The research reported in this paper examines information usage behavior of the elderly based on a survey consisting of 1060 personal interviews. An examination is made of the sources of information for health care services utilized by the elderly based on demographics and behavioral dimensions.

Some health data organizations (HDOs) are producing consumer-level health services information. National reform proposals would suggest that competition between health plans will be developed through the use of outcome information. Policy makers have paid little attention to how consumers might use that information or how that information might be most effectively packaged for consumer use. This paper argues that marketing literature developed over the last ten to fifteen years could prove to be an informative resource for policy makers and the health services provider community alike. This paper suggests that combining a consumer decision model (CDM) with the health belief model (HBM) will provide an important step toward an increased understanding of consumer information search behavior. This integrated model could form the basis of future research in this important area.

The research presented focuses on an examination of the relative importance of word-of-mouth, expert opinion, external communication, and past experience in the context of hospital choice. Past research has examined the effect of each individually and various combinations of the four sources, but not all four simultaneously. Results of the present study suggest that past experience plays a greater role in hospital choice than other information sources, including expert opinion. The strength of word-of-mouth as a source of information is also verified. The implications of this research include the following: (1) health care researchers need to incorporate word-of-mouth when investigating informations sources, and (2) local hospitals need to be aware of "negative perceptions" and strive for consumer satisfaction. Health care delivery systems incorporating consumer-based choice render these findings especially valuable as researchers and practitioners address the challenges that these evolving systems will bring.

The purpose of this paper is to discuss the need to provide access to information to support informed medical decision-making and to describe a working model for delivering such information. We report the findings on the users of an independent health information service (n = 1083), including: who uses this type of service; the types of information requested; and, the benefits for individuals and health care organizations.

A critical review of the literature is undertaken to examine the state of the art and degree of articulation of theories, methods, and findings between health care marketing and the traditional "generic" marketing literature as related to knowledge of information use by and advertising to the elderly consumer. Evaluative criteria suggestive of scientific rigor are applied to this domain as consistencies, discrepancies, and gaps are identified. Recommendations for future research are advanced.

Of 386 consumers surveyed nearly two years after the federal government's initial release of hospital mortality ratings, a majority were unaware of the data. Once made aware of their availability, however, the majority indicated they would use those data with other traditional indicators of quality to influence their choice of hospital.