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Physicians have differing motives for using the Internet and Internet-related services in their professional work. These motives may affect their evaluation of patients who bring with them health-related information from the Internet. Differing motives may also affect physician–patient communication and subsequent prescribing behavior.
To segment physicians into types based on their motives for using the Internet in connection with professional activities and to analyze how those segments differ in their attitudes in three areas: toward patients who bring along Internet-sourced information; in their own subsequent prescribing behavior; and in their attitudes toward using the Internet to communicate with patients in future.
We surveyed 287 German physicians online from three medical fields. To assess physicians’ motives for using the Internet for their professional activities, we asked them to rate their level of agreement with statements on a 7-point scale. Motive statements were reduced to motive dimensions using principal component analysis, and 2-step cluster analysis based on motive dimensions identified different segments of physicians. Several statements assessed agreement or disagreement on a 7-point scale physicians’ attitudes toward patients’ bringing Internet information to the consultation and their own subsequent prescribing behavior. Further, we asked physicians to indicate on a 7-point scale their valuation of the Internet for physician–patient communication in the future. Data were then subjected to variance and contingency analyses.
We identified three motive dimensions for Internet use: (1) being on the cutting edge and for self-expression (Cronbach alpha = .88), (2) efficiency and effectiveness (alpha = .79), and (3) diversity and convenience (alpha = .71). These three factors accounted for 71.4% of the variance. Based on physicians’ motives for using the Internet, four types of physician Internet user were identified: (1) the Internet Advocate (2), Efficiency-Oriented, (3) Internet Critic, and (4) Driven Self-expressionist. Groups differed significantly concerning (1) their attitude toward informed patients in general (
Based on self-reporting by German physicians of their motives for professional Internet use, we identified four types of Internet users who differ significantly in their attitude toward patients who bring along Internet information and their attitudes toward using the Internet to communicate with patients in future.
The Internet has become an important tool for finding medical information and in medical care. Increasingly physicians are using Internet services in their professional work. However, little is known about the motives behind physicians’ use of Internet services. In this research, we analyzed physicians’ motives for professional Internet use. We segmented physicians based on their motives for professional Internet use and analyzed how the segments differ with regard to their attitude toward patients who bring information taken from the Internet to a consultation with their doctor, physicians’ related prescribing behavior, and their attitudes toward the possibilities for Internet communication with patients in the future. Previous surveys have particularly concentrated on physicians’ use of specific media channels (eg, email) [
The paper addresses the following research questions: (1) What different types do physicians fall into based on their motives for using the Internet for professional activities? (2) How do segments differ with regard to their evaluation of patients who bring Internet information to a consultation? (3) How do physicians differ with regard to the pressure they feel to prescribe a requested pharmaceutical when a patient brings along information from the Internet? (4) How do they differ with regard to their attitude toward using the Internet to communicate with patients in future?
In our study, we segmented physicians based on their motives for professional Internet use. Motives are strong driving forces of human behavior [
Because the Internet offers broad and easy access to health-related information [
With the growing volume of publically available information, patients may want to be increasingly involved in the decision-making process. Results of empirical studies among physicians are mixed. In a study among Greek physicians, results indicate that physicians are still autonomous, and only 11% would prescribe a medication requested by the patient [
The Internet has already become a common tool for physicians’ activities: it is used to seek information, to post content in blogs and on bulletin boards, and to communicate with other medical professionals [
We surveyed 287 German physicians in December 2010 and January 2011. The survey contained a set of questions about use of the Internet, attitudes toward Internet-informed patients, prescribing behavior, and attitudes toward Internet communication in the future. The sample was drawn from a physicians’ e-panel maintained by GfK HealthCare, a survey research company in Nuremberg, Germany. The sample was based on a randomly generated set of physicians stratified by medical field, consisting of general practitioners (n = 127), orthopedists (n = 80), and dermatologists (n = 80). The survey was continued until the determined number of participants had taken part (for a detailed summary of the survey, see
To assess the physicians’ motives for using the Internet for their professional activities, we gave respondents a list of statements relating to their professional work and asked them to state their level of agreement with the statements on a 7-point scale (1, strongly disagree; to 7, strongly agree). For example, one statement was “The Internet offers an opportunity to express oneself” (see
We assessed this by asking about the level of agreement (1, strongly disagree; to 7, strongly agree) with statements concerning the physicians’ general attitude toward these patients; whether the physician expected an improvement in the physician–patient relationship; whether he or she expected wrong or misunderstood information; whether he or she expected a more time-consuming consultation; and whether he or she perceived a loss of authority and control. For example, one statement was “If a patient brings health-related information from the Internet in consultation, I think it is generally positive.” (See
We investigated prescribing behavior by rating the level of agreement (1, strongly disagree; to 7, strongly agree) with the statement “If a patient brought some health-related information to the consultation, I would be more likely to prescribe a desired medication than if the patient was uninformed.”
We asked “Could you imagine using the Internet for communication with your patients more often in the future?” Responses to this question were rated on a 7-point scale (1, I absolutely cannot imagine; to 7, I can easily imagine).
Principal component analysis with varimax rotation revealed that motives had three underlying factors (motive dimensions). The factors were (1) being on the cutting edge and for self-expression (Cronbach alpha = .88), (2) efficiency and effectiveness (alpha = .79), and (3) diversity and convenience (alpha = .71) (
On the basis of the motive dimensions for using the Internet for professional activities, we identified four types of Internet user by a 2-step cluster analysis: (1) the Internet Advocate, (2) the Efficiency-Oriented physician, (3) the Internet Critic, and (4) the Driven Self-expressionist (
Principal component analysis with varimax rotation of physicians’ motives for using the Internet for professional activities.
Motive dimension | Factor 1 | Factor 2 | Factor 3 | |
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It is important to be on the Web as a physician | 0.892 | 0.173 | 0.041 | |
It offers an opportunity to express oneself | 0.890 | 0.122 | 0.132 | |
I want to be on the cutting edge | 0.790 | 0.159 | 0.220 | |
I want to keep up with other physicians | 0.748 | –0.022 | 0.276 | |
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I can look for information easily | 0.061 | 0.896 | 0.047 | |
It offers a vast amount of information | 0.053 | 0.882 | 0.185 | |
It offers current information | 0.049 | 0.601 | 0.506 | |
I want to save time | 0.255 | 0.581 | 0.134 | |
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The information is easy to understand | 0.188 | 0.180 | 0.826 | |
It offers different formats, eg, social networks, podcasts, or health bulletin boards | 0.278 | 0.164 | 0.794 | |
Eigenvalue | 4.198 | 1.933 | 1.005 | |
Variance explained | 29.597 | 24.103 | 17.665 | |
Cronbach alpha | .88 | .79 | .71 |
Analysis of user segments based on motive dimension, mean of factor values (SD).
Motive dimension | User type |
|
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Internet |
Efficiency- |
Internet Critic |
Driven Self- |
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Cutting edge and self-expression | 0.683 (0.548) | –1.050 (0.508) | –0.261 (0.865) | 0.711 (0.646) | 166.946 | <.001 |
Efficiency and effectiveness | 0.085 (0.556) | 0.314 (0.559) | –2.214 (1.158) | 0.518 (0.450) | 138.868 | <.001 |
Diversity and convenience | 0.675 (0.450) | 0.000 (1.026) | –0.470 (0.900) | –1.071 (0.667) | 61.601 | <.001 |
Characteristics of user types.
Characteristic | No. | User type | Total |
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|
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Internet |
Efficiency- |
Internet |
Driven Self- |
||||||
|
16.7 | .01 | |||||||
General practitioner | 123 | 54 (44) | 45 (37%) | 7 (6%) | 17 (14%) | 100.0% | |||
Orthopedist | 77 | 28 (36%) | 18 (24%) | 11 (14%) | 20 (26%) | 100% | |||
Dermatologist | 74 | 19 (26%) | 30 (40%) | 11 (15%) | 14 (19%) | 100% | |||
|
4.1 | .26 | |||||||
Male | 231 | 84 (36%) | 78 (34%) | 22 (10%) | 47 (20%) | 100.0% | |||
Female | 43 | 17 (40%) | 15 (35%3) | 7 (16%) | 4 (9%) | 100% | |||
|
1.7 | .95 | |||||||
30–42 | 37 | 16 (43%) | 10 (27%) | 3 (8%) | 8 (22%) | 100% | |||
43–55 | 169 | 60 (36%) | 60 (36%) | 18 (11%) | 31 (18%) | 100.0% | |||
56–64 | 67 | 25 (37%) | 22 (33%) | 8 (12%) | 12 (18%) | 100% | |||
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Private use | 274 | 1.62 | 1.15 | 1.55 | 1.21 | 1.38 | 4.173 | .01 | |
Professional use | 274 | 1.25 | 0.83 | 0.87 | 0.82 | 0.99 | 3.351 | .02 | |
|
270 | 6.09 | 5.61 | 4.85 | 5.73 | 5.74 | 7.433 | <.001 | |
|
6.0 | .42 | |||||||
Chronic | 34 | 14 (41%) | 8 (24%) | 4 (11%) | 8 (24%) | 100% | |||
Acute | 6 | 4 (66%) | 0 (0%) | 1 (17%) | 1 (17%) | 100% | |||
Both equally | 234 | 83 (36%) | 85 (36%) | 24 (10%) | 42 (18%) | 100.0% |
a 1, strongly disagree; 7, strongly agree.
The
The
The
The
Attitudes toward patients who bring information from the Internet to a consultation differ significantly between the four physician groups (see
Analysis of differences between user types based on mean scoresa.
Attitude | User type | Total |
|
|
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Internet |
Efficiency- |
Internet |
Driven Self- |
|||||
|
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Positive attitude in general | 5.21 | 4.27 | 3.90 | 4.18 | 4.56 | 9.215 | <.001 | |
Improvement of physician–patient relationship | 4.68 | 4.05 | 3.59 | 4.06 | 4.24 | 5.386 | <.001 | |
Wrong and misunderstood information | 5.59 | 5.44 | 4.97 | 5.88 | 5.53 | 3.658 | .01 | |
Time-consuming consultation | 4.97 | 5.27 | 4.17 | 5.12 | 5.01 | 3.356 | .02 | |
Loss of authority and control | 2.80 | 2.60 | 2.83 | 3.06 | 2.78 | 0.879 | .45 | |
Attitudes toward prescribing a patient’s desired medication | 3.28 | 2.86 | 2.66 | 3.24 | 3.06 | 1.910 | .13 | |
Attitude toward using the Internet for communicating with patients in future | 4.91 | 3.36 | 2.18 | 4.45 | 4.02 | 23.242 | <.001 |
a 1, strongly disagree; 7, strongly agree.
With regard to physicians’ attitudes toward the information level of patients in general, the Internet Advocate had the most positive attitude, with a mean of 5.21, compared with the Efficiency-Oriented (4.27), the Driven Self-expressionist (4.18), and the Internet Critic (3.90;
There were no differences between the four segments with regard to the pressure they felt to prescribe a medication that a patient requests depending on whether the patient is informed (
Attitude toward using the Internet for communication with patients in the future differed significantly (see
Whereas academic literature has focused particularly on patients’ use of the Internet for medical content, our survey examined Internet use from the physicians’ perspective. On the basis of physicians’ self-reported behavior, we were able to show that physicians use the Internet for different reasons and that four types of physicians can be identified, based on their motives for professional Internet use. We labeled these physician types (segments) the Internet Advocate, Efficiency-Oriented, Internet Critic, and Driven Self-expressionist. Segments differed with regard to attitudes toward patients who bring health-related Internet-sourced information to a consultation and in their attitudes toward future communication with patients via the Internet. Prescribing behavior did not differ. The results of the survey enabled us to identify physicians’ attitudes toward Internet-informed patients and thus to increase our understanding of physicians’ behavior. The Internet Advocate is open-minded toward the Internet and, for instance, uses social media for professional activities, whereas the Efficiency-Oriented physician primarily uses the Internet because of its efficiency, such as ease of use and saving time when looking for information. The Internet Critic refuses to use the Internet for professional activities, and the Driven Self-expressionist primarily uses the Internet for self-expression. We therefore found that the Internet is used as an information or communication tool in the medical field for different motives. Our investigation revealed that physicians’ willingness to use the Internet for communication with patients in future differed clearly between the physician segments. In particular, Internet Advocates and Driven Self-expressionists could imagine that Internet-based communication will be used more often in future. However, the Efficiency-Oriented and Internet Critic are more reluctant. Finally, if the goal is to prepare physicians for increased Internet use, results suggest that it would be best to address physicians individually according to their established motives for use. Whereas Internet Advocates could be given support in intensifying their use of social media in the medical practice and in providing reliable Internet sources to their patients, Efficiency-Oriented physicians could be informed about further tools to broaden their employment of the Internet for professional activities and become more open to participative Internet use. Driven Self-expressionists are focused on certain Web tools; thus, they could be helped to intensify and extend use of certain Web tools—for instance, to use the Internet for communication rather than just for self-expression. Regarding Internet Critic, it might be important to demonstrate the efficiency and effectiveness of certain Web tools to overcome defensive attitudes. However, given their negative attitude toward the Internet, great efforts may be necessary to change their estimation of the usefulness of the Internet and related applications.
Several limitations of this study deserve comment. Our sample was drawn from a physician e-panel, and we conducted the survey by using an online questionnaire. Therefore, only physicians with Internet access and the ability to use the Internet were able to participate. We did not include questions concerning physicians’ Internet literacy in the survey; therefore, we could not consider the possible relations between the physicians’ history of Internet use and user intentions. Given that we used an e-panel, it is possible that physicians with more positive attitudes toward the Internet were overrepresented in the sample.
Questions and justification of items.
Summary of the survey.
Contingency analysis of user segments.
The data used in this article were collected within the GfK HealthCare. We gratefully acknowledge the contributions of Susanna Meyer, Norbert Schell, and Stefania Pisu-Maceri for their efforts in the creation of an online format for the questionnaire and the collection of the data.
None declared.