By Paul Martin FAPS APS President
There are more people looking for health information online on a typical day than are actually seeing a doctor, according to Director of Research at the Pew Internet and American Life Project, Susannah Fox, recently quoted in Habit www.cfah.org.
The Pew Project involves surveys of Internet use in the United States, and one survey revealed that 52 million American adults, or 55% of those with Internet access, have used the web to get health information. Most individuals seeking health information online begin with general search engines like Yahoo! or Google, but email groups, special Websites and support networks are becoming increasingly popular, especially with care givers. More internet users have sought health information on the Web than have shopped online, looked up share prices, or checked sports scores.
Less information is available about Australia, but the percentage of homes with computers has always been high in Australia compared with, for example, Europe. The Australian Bureau of Statistics (ABS) ran a survey on 'Use of the internet by householders' between 1998 and 2000, which showed that in February 1998 approximately one in eight households had home internet access compared to one in three by November 2000. The survey predicted that before the end of 2001, every second household would have home internet access. Of course, it is difficult to imagine in 'sports-mad' Australia (where Shane Warne's drug hearing received more media coverage than almost any other national or international event) that more people would turn to the Web for health information than sports results!
Some of the Websites have been developed by health professionals and some have not. Azy Barak recently published a review of psychological applications on the Internet and divided them into 10 categories including:
Parenthetically, the APS Board has recently established a Working Group to review current national and international guidelines for the provision of Internet psychological services, and to draft a set of ethical guidelines for such services.
What implications do these developments have for the community on the one hand, and the discipline and profession of psychology on the other? With respect to the community, the new and rapidly developing technology, and increased access to it, present exciting, novel possibilities. The Web can provide treatment at no cost, therefore potentially benefiting low-income earners, although the ABS survey shows, not surprisingly, that access to the Internet is less common in the homes of the economically disadvantaged. Services via the Web can reach rural and remote areas that are not well serviced by health professionals, although again the proportion of homes with Internet access is lower in such regions than in metropolitan areas.
On the other hand, the Internet is an uncontrolled environment and so there are dangers associated with Websites providing information that is unsubstantiated, incorrect or even exploitative. Susannah Fox reported that only one-quarter of Americans seeking health information on the Web checked the date and source of the information. The Australian Government is well aware of the problem, and one reaction was to launch at the end of 2002 a new website: www.healthinsite.gov.au
The goal of this initiative is to provide reliable health information online, and the site currently has 40 main categories of information including several in the mental health domain. The site has been developed in partnership with the National Health & Medical Research Council (NHMRC). It follows a Code of Conduct for medical and health Websites (HONcode), developed by a foundation related to the United Nations. The APS Director of Science, Professor Trang Thomas, is on the Editorial Board for this site. I would recommend to all psychologists with an interest in health to bookmark this site, and to promote it to other health professionals and clients.
With respect to implications for psychologists, almost every article on health and the Internet concludes that practice has far outstripped research and evaluation, so there are plenty of opportunities for psychologists given our strong skills in this domain. As the literature has developed, new journals have been established such as Computers in Human Behavior (1985) and Cyber Psychology & Behavior (1998). Research in this field is already underway in Australia with, for example, Professor Jeff Richards, a past APS Director of Training and Standards, recently winning an NHMRC grant for evaluating an online treatment program for panic disorder.
Practitioners may feel threatened by a loss of work as people turn to the Web for help rather than see health professionals, but survey findings don't support such fears. The Pew Project, for example, concluded that only a small percentage of 'health seekers' used the Web in lieu of a doctor's visit. Most users of the Internet sought information in conjunction with a visit to a doctor. Also of relevance to psychologists, searches related to physical illness are far more common than those related to mental health.
Most importantly, the Internet developments provide new opportunities for professionals to extend the scope of their practices. Use of the Web is likely to increase pressure for practitioners to engage in more professional development activities, as a common response in surveys is for people to report that a consequence of their Internet 'research' is they have more up-to-date information on their problems than the health professionals who they have consulted. It may also increase the pressure to offer evidence-based interventions if, as seems likely, such approaches are promoted by government sponsored/approved sites.
Perhaps in the future we will see an APS Interest Group established in this domain. (Note: in 2004, the Telephone and Internet Based Counselling and Psychology Interest Group was formed.
Barak, A. (1999). Psychological applications on the Internet: A discipline on the threshold of a new millennium. Applied & Preventive Psychology, 8, 231-245.