The World-Wide-Web or internet has become an important source of information including medical information globally. Many patients or their relatives, especially in an urban area have an easy access to the internet and routinely make use of it to obtain medical information. Various investigators have critically evaluated the websites and the patient-oriented medical information on internet in the past and found them scientifically inaccurate, incomplete and biased. Nevertheless, patients as well as professionals around the world continue to rely on the internet for deriving important information regarding their health conditions and its management. Despite such a popular trend, there is no study that has evaluated the impact of the internet on the patient's knowledge so far.
In this study, we have found a few advantages and limitations of using internet for obtaining the medical information by the patient. The data presented in this study would would help the clinicians inform their patients on what to rely and how much to rely on the internet for their health needs.
The study was performed between 31st March, 2012 and 30th Jun, 2012. The parents of children with a squint and amblyopia, having an access to internet at home and/or office and who would access the internet on daily basis were given a questionnaire [Table 1]. Only those parents who had not visited an ophthalmologist prior to this visit and who had not done an internet search relevant to the study were included. The parents were first informed that the child had a significant strabismus and required further evaluation three days later. The child was prescribed atropine eye ointment for 3 days for cycloplegic refraction as was the routine protocol of the clinic.
The parents were given a questionnaire and explained the purpose of this study. After an oral consent, the parents were recruited in the study.
Completely filled questionnaire was returned on the follow-up visit that was scheduled within a week. Each answer was scored (0 for no/wrong answer and +1 for the correct answer), and cumulative scores were analyzed. Paired t-test was performed to compare the total score before and after the Google Search. P < 0.05 was considered as statistically significant.
Sample size calculation
For 80% power, 5% level of significance, 3.0 standard deviation and 20% effect size we needed n = (Z1−α/2− Z1−β)2 Sd2/d2 that is, 18 patients.
Twenty-one consecutive parents were recruited in the study. About 48% were graduates and 52% were postgraduates. About 52% respondents were mothers, rest 48% were fathers. Mean total score before Google Search was 3.8 out of a maximum 8 (standard deviation 1.9, range 0–7). Mean total score after Google Search was 5 (±2.1, 1–8). This difference was statistically significant (P = 0.003).
Before Google Search, the lowest awareness about the squint was found to questions 3 and 7. About 76% parents were not aware of the potential defects that occur due to a squint or aware of the correct success rates of the squint surgeries [Fig. 1]. Highest positive impact of Google Search was seen on question 3 (47%) and 2 (39%). In 1 patient, negative impact of Google Search was seen on question 5 [Fig. 2].
Google Search engine is frequently accessed by the patients coming to our clinics for obtaining relevant medical information. Many patients would have either visited multiple websites prior to meeting us or browse through them after we have informed them about the medical diagnosis. Despite multiple studies reporting the lack of accuracy and reliability of internet for obtaining the information, we believe this trend of referring to internet will continue. The medical fraternity needs to provide unbiased and scientific guidelines to their patients on what to rely and what not to rely when using the internet.
In this study, we found that Google Search had a positive impact on the knowledge of the patients regarding the disease. However, the information was incomplete and many times biased with regards to the treatment protocols and outcomes. The study demonstrated that the internet was a reliable source of information for the etiopathogenesis and the defects due to the disease. That information remained unbiased, was obtained from the books and authentic research papers, and there were no commercial interests in that information. However, the information regarding the treatment was controversial and had a major commercial angle to it when the contents of the websites were evaluated by the co-author from the first 10 websites on “Google” search engine for the keywords “squint” using Table 2.
We encourage the patients to use internet to know more about their disease albeit with the knowledge that the information on the etiopathogenesis and the disease associated handicap would be reliable. The information about the treatment could be incomplete, frequently written by nonexperts and with the commercial objectives.
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Source of Support: Nil.
Conflict of Interest: None declared.