Elsevier

Computers in Human Behavior

Volume 73, August 2017, Pages 141-151
Computers in Human Behavior

How people with hearing impairment in New Zealand use the Internet to obtain information about their hearing health

https://doi.org/10.1016/j.chb.2017.03.037Get rights and content

Highlights

  • Adults with hearing impairment use the Internet to search for hearing health information.

  • Participants selected websites based on many factors, including familiarity, and layout.

  • Trust was an important aspect of selecting websites to visit.

Abstract

The aim of this study was to explore if and how people with hearing impairment in New Zealand are using the Internet to find hearing related information. Eleven participants with various degrees of hearing impairment completed three questionnaires relating to their hearing impairment and Internet use. Each partook in an Internet search task requiring them to answer set questions related to hearing impairment. During this task they were asked a combination of closed-set and open-set questions about their decision-making and opinions about different websites. A majority of the participants had previously used the Internet to find hearing related information and their processes for choosing and evaluating websites were similar to those of participants in studies of other health-related industries. These findings may help to provide further understanding of how hearing-related information on the Internet could affect the audiology industry and what considerations may be important for those wishing to develop appropriate hearing-related websites.

Introduction

In today's world, the Internet is considered an integral source of information for many people. The International Telecommunications Union estimated that in 2014(a) approximately 78% of individuals in developed countries were using the Internet, compared to 51% in 2005. Similar statistics have been found in New Zealand where it was reported that home Internet use penetration rate was around 80% in 2012 (Statistics New Zealand – Tatauranga Aotearoa, 2012a). This increasing accessibility has had a particular effect on the way people consume health information.

For people with hearing impairment (HI), the Internet offers a channel of communication and source of information which is visually based and therefore possibly preferential due to the lack of auditory barriers, as was found in a study of adolescents with HI (Barak & Sadovsky, 2008). Based on trends surrounding the accessing of general health information on the Internet, it is possible that people with HI will be increasingly using the Internet to find relevant information. This could have significant effects on the way people make decisions about managing HI and how they interact with their hearing professional.

The Internet is a widely used tool and source of information for people across the world. Europe has the highest Internet penetration rate with approximately three out of four people accessing the Internet in 2014 (International Telecommunications Union, 2014b). The Americas (North and South) have an estimated two out of three people using the Internet, representing the second highest penetration rate (International Telecommunications Union, 2014b). Internet usage in New Zealand reflects similar patterns to those found in other developed countries (Eurostat, 2013, Pew Research Center, 2014, United States Census Bureau, 2014). For individuals between the ages of 15 and 64 years, the rate of those with Internet access at home was around 83% in 2012. The usage rate decreases with age, beginning at 65 years of age and decreases to approximately 50% for individuals 75 years and older (Statistics New Zealand – Tatauranga Aotearoa, 2012b). People of European descent are significantly more likely to have accessed the Internet recently compared to those of Māori and Pacific Island descent (Statistics New Zealand – Tatauranga Aotearoa, 2012b).

A study of key trends in Internet use in New Zealand from 2007 to 2013 revealed a number of interesting findings (Crothers, Gibson, Smith, Bell, & Miller, 2014). In 2013, 73% of Internet users indicated they felt that the Internet was important to everyday life, and 63% of users felt they had “good ability” to use the Internet. A total of 81% of participants rated the Internet as an important information source, making the Internet the highest rated source of information when compared to television, radio, newspapers or other people. In 2007, 46% of participants stated they believed the Internet to be reliable. Interestingly, this figure did not change in 2013. However, the number of people who believed Internet information is unreliable decreased from 16% in 2007 to 7% in 2013, indicating a growing number of people have neutral feelings about the information they find as opposed to a distrust (Crothers et al., 2014).

Fox (2011a) reported that accessing health information online is the third most common use of the Internet after email and search engine use. Fox (2011b) reported that 80% of all Internet users in the US were using the Internet to search for health information, translating to approximately 59% of all adult Americans. Medlock et al. (2015) looked specifically at adults aged 67–78 years of age living in the Netherlands who access the Internet. Their results indicated that the Internet was among the most commonly used sources, along with information from health professionals and pharmacists. There is very little recent research on how people in New Zealand are using the Internet for health information. However, a survey of New Zealanders by Gauld & Williams, 2009 found that 19.5% of respondents used the Internet to find health information. Crothers et al. (2014) reported that 82% of Internet users in New Zealand used the Internet to find health information at least occasionally.

A number of studies have revealed a variety of characteristics that are related to people being more likely to search the Internet for health information. A systematic review by Anker, Reinhart, and Reeley (2011) reported that females, those with higher education and those with greater income were more likely to use the Internet to find information about health-related topics. Additionally, people with a Caucasian racial background and those that were younger were also more likely to search for health topics on the Internet. This theme of difference in accessibility is sometimes called the “digital divide”, a theory used to refer to the gap between individuals, households and geographic areas of different socio-economic standing with regards to their access to and use of digital equipment and services (Anker et al., 2011, Sparks, 2013).

Bundorf, Wagner, Singer, and Baker (2006) undertook a study to determine what types of consumers source health information from the Internet. Their findings suggested that those individuals with the highest costs and possible benefits associated with seeking health information were the most likely to use the Internet to source that information. In particular, those with a chronic illness were more likely to utilize the Internet for health information compared to those without a chronic illness. Similarly, individuals who were uninsured and had chronic illness were more likely to seek health information on the Internet compared to those who were privately insured. A long travel time to the usual source of health care also indicated a stronger likelihood of using the Internet to find health information.

It is important to consider when an individual decides to search the Internet in relation to healthcare decisions. In 2005, Hesse and colleagues studied a group of adults and their online health activities and found that 48.6% of the participants searched for health information online before visiting their health professional. However, of the participants using the Internet for health information in the study by Medlock et al. (2015), most were seeking information after attending an appointment with a healthcare professional while only half as many reported seeking information to prepare for an appointment or to decide if a doctor's appointment was necessary.

With the growth of the Internet as an information source for health-related topics, there have been a number of concerns raised regarding the potential risks and benefits of using this medium. While Cline and Haynes (2001) identified a number of benefits such as interactivity, anonymity and tailoring of information, they also discussed the risks associated with searching for health information online. These included inequality of accessibility due to the digital divide and navigational issues such as search difficulties, overloading of information on websites and lack of understanding due to overly technical language used. They also discussed the issue of quality, suggesting that lack of peer review, dangerous or misleading information and consumer evaluation skills could result in misinformation. These concerns have been raised in a number of other studies (e.g., Adams, 2010, Risk and Petersen, 2002, Sa et al., 2002).

The suitability of the Internet as a source of health information for consumers has been called into question for several reasons. Given the ease with which information can be uploaded to the Internet, a number of these reasons relate to the content, quality and readability of the content available. Studies in a number of different health-related fields have assessed the quality and validity of relevant information available online and in most cases quality was found to be poor (Caron et al., 2007, Fast et al., 2012, Maloney et al., 2005). Sa et al. (2002) completed a systematic review evaluating the quality of health-related information on the Internet and found that 70% of the studies concluded that the quality of the information was inadequate. These findings extend to the quality of information on the Internet relating to hearing health information (e.g., Atcherson et al., 2014, Laplante-Lévesque et al., 2012).

These findings are concerning given that many people searching the Internet for health information are likely to be influenced by the information and advice they find (Mead, Varnam, Rogers, & Roland, 2003). While there are a number of different tools available for analyzing the quality of Internet health information (Bernstam et al., 2005, Laplante-Lévesque et al., 2012) consumers often do not methodically analyze the quality of the health information they are accessing. In fact, Gauld (2011) found that older adults in Australia and New Zealand were more likely to perceive the health information they found on the Internet to be reliable, yet less likely to check website provider credentials when compared with younger adults. Similarly, a qualitative study by Eysenbach and Köhler (2002) suggested that consumers did not read disclosure statements or check website ownership despite their understanding that identifying a source is an important part of assessing the credibility of a website. This information is now somewhat dated however it was found to be the most recent study of its kind.

A study was undertaken in Sweden to investigate the extent to which adults with HI use the Internet (Thorén, Oberg, Wänström, Andersson, & Lunner, 2013). Questionnaires about Internet access and email use were completed by 158 hearing aid users ranging in age from 31 to 96 years. The findings indicated that approximately 60% of participants had a computer at home and nearly all of the computer owners had access to the Internet. This penetration rate appears low but may be explained by the fact that the mean age of the participants was 73.6 years and Internet use rates decline over the age of 65 years (Selwyn et al., 2003, Statistics New Zealand, 2012b). Interestingly, Thorén et al. (2013) found higher rates of Internet use in the participants with HI when compared to the same age groups of Sweden's general population aged 65 years and older. From this, the researchers concluded that the Internet may be a valuable rehabilitation tool which older adults with a HI can access from home.

Henshaw, Clark, Kang, and Ferguson (2012) explored how HI might impact personal computer and Internet use in adults aged between 50 and 75 years living in the UK. Data were collected with postal questionnaires about hearing difficulty, personal computer skill and Internet use. They found that personal computer and Internet use were greater in the younger participants compared to the older participants. They also found that Internet use was greater in those who reported a slight hearing difficulty compared to those with no hearing difficulties. However, for those participants with more than moderate hearing difficulty, Internet use rates were lower when compared to those with no hearing difficulty. Based on these findings, the researchers suggested that the Internet may be an effective method of providing information about hearing health to those individuals who experience some hearing difficulties but may be less likely to visit a hearing professional (i.e., those with milder forms of HI).

It is certainly possible that the Internet has had an impact in the hearing health field, however there appears to be little published research as yet to understand this impact. The limited research which has been published suggests that individuals with HI access the Internet at least as much as the general population. It also suggests that a significant portion of the hearing health information that is available online appears to vary widely in readability and quality and may not always be appropriate for consumer use.

It would be useful to understand what information people with HI are accessing on the Internet in relation to hearing health, if anything. Specifically, it would be helpful to understand how people choose which websites to visit, how they evaluate the information they find and how they feel that information influences their hearing health decisions. This information would be of particular use for those developing online information for people with HI. As there are no published studies investigating these topics, this study aimed to evaluate how people with HI living in New Zealand are using the Internet to obtain hearing health information. It is hoped that this study can provide some awareness around how much emphasis is being placed on online hearing health information by consumers in New Zealand and how it might influence their hearing health decisions. This information could also help in building an understanding of how the Internet can be utilized by hearing professionals to best serve their clients and what factors should be considered by those developing hearing health information for online consumption.

Section snippets

Participants

Participants for this study were recruited using advertisements that were posted in several locations in Christchurch, New Zealand including: libraries, cafés, and in audiology clinics. Recruiting was also accomplished through word of mouth and invitation to those on an existing research database. The sample size was not known a priori. Instead, data were collected until saturation was reached. This refers to the point at which data collection from two consecutive participants did not result in

Sample characteristics

A total of 11 participants were interviewed for this study in order to reach data saturation. The age of the participants ranged from 44 to 84 years and the median age was 70 years. Table 1 displays the demographic data gathered from each participant.

Of the 11 participants, 10 owned hearing aids and one did not. The participant with no hearing aids had a mild high frequency HI so that his worst ear pure tone average (WEPTA) was within normal limits. Table 2 displays the detailed audiometric

Internet users

The results of this study suggest that at least some people with HI are using both a computer and the Internet on a regular basis, with all of the participants in this study indicating that they use the Internet more than once a week. Given that the median age of the participants was 70 years, this usage is high when compared to the literature as information from Statistics New Zealand- Tatauranga Aotearoa (2012b). However, it should be kept in mind that when recruiting for this study,

Conclusion

This study aimed to gain an understanding of how people with HI in New Zealand are using the Internet to obtain hearing health information. The results of this study suggest that at least some people with a HI use the Internet to search for information on hearing health. Results also highlighted a number of ways in which people may choose to look at certain websites and how they evaluate those websites. Interestingly, these factors were in agreement with previous research undertaken in general

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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