Dr. Saurabh N Shah, Dr. Shreya Shah, Dr. Jayesh D. Modhwadia, Dr. Pritesh Taori
Google:
A Novel Tool in Ophthalmology for Patient education and counselling
ABSTRACT:
‘Google search’ provides plenty of information including medical topics, although many sites provide incomplete,misleading & scientifically inaccurate medical data.
AIM: To assess effects of Google search on patient knowledge & determine if clinician can rely on internet for IEC activity
METHODS: 123 consecutive patients having INCIDENTAL FINDINGS of glaucoma & diabetic retinopathy.Alleducated,with internet access,not previously counselled/treated.QUESTIONNAIRE was filled by patient.We gave pre-tested KEYWORDS for search &study on internet.On next visit,same questionnaire was filled.SCORE Correct +1 Wrong 0
RESULTS: BEFORE GOOGLE SEARCH score-Mean 4.6,max 7,range 0-7.AFTER GOOGLE SEARCH Mean 8.86,max 10,range 4-10.Statistically significant improvement.
CONCLUSION: ’Google search’ has positive impact on patient knowledge.Internet seems feasible helping tool for IEC, but we cautiously guide patients to access internet-based medical data in proper way like providing ‘key words’ for Google search.
Co Author : Dr Shreya Shah, Dr JayeshModhwadia, Dr Pritesh Taori
Introduction:
“We can just Google it !!!” is becoming our standard response to unanswered questions in life. (fig.1)
Fig.1. Google Homepage: Gateway for ocean of information.
Today’s technology provides new ways in health care. The Internet, especially the World Wide Web, has a wealth of health-related information easily accessible to patients and families.GOOGLE™ search engine listed more than 90% of all web-pages available online on the web. Its popularity has increased, and it has now become a source of patient education and information, although It is unregulated for the quality of its search results.
A growing concern among health care professionals is the quality and overabundance of patient education information available on the Internet.
‘Google search’ provides plenty of information including medical topics, although substantial portion of medical information on the Internet provide unchecked, disorganized collection of resources which may be incomplete, misleading & scientifically inaccurate medical data. Realizing this, many patients would like their physicians to help guide their online searches for medical information, but most physicians do not feel comfortable enough with the Internet to provide this service. A poll by Cyberdialogue (2000) found that 70% of all patients would like their physicians to recommend a health care web site for their condition, but that only 4% of patients receive such a recommendation.[1]
According to the 2012 Pew Research Center’s Internet & American Life Project Survey, 80% of adult Internet users search for health related topics.[2]Many physicians perceive Internet health information as problematic as they feel it generates patient misinformation and an inclination towards detrimental self-diagnosis (Ahmad 2006). However, studies have shown that patients who use the Internet are often more compliant, have better medical results, and arrive at their appointments asking specific and informed questions (Garcia 2011).Several organizations have recognized the importance of training the public about Internet usage for their healthcare needs and have suggested courses for health care professionals with the intention to disseminate skills such as conducting searches, assessing website quality, and using the relevant information to educate their patients (McNullen 2006).
HOW TO USE GOOGLE SEARCH??
Answer as per google help:
Fig.2: How to search on Google. Search help by Google.
So the question arises “Does the quality, accuracy, and reliability of information about medical condition on the internet vary with the search term used?” On Literature search we found the answer that reliable information is available online…However, the quality and accuracy of information vary significantly with the search term, website author, and order of search results. This leaves less educated patients at a disadvantage, particularly because the information is above the level of general public as they use layman terms and generic vague terms for search their medical condition.[1]So we have used “KEYWORDS” to search medical information and assess Internet
[1]Marissa N.Teaching Patients to Effectively Utilize the Internet for Healthcare Information. MedEdPORTAL Publications. 2014.https://www.mededportal.org/icollaborative/resource/2193
sources with “GOOGLE Search Tool” to enable patients to utilize the Internet effectively to better supplement their care.
GOOGLETM noted that one in 20 searches made online is health related. In India, the doctor to patient ratio is also something concerning, Google notes. It’s roughly at 1 doctor for 11,500 patients. Google launched its health search feature in India, powered by Knowledge Graph. Google health, which is now live in the country, returns relevant and verified medical details, presented as cards, on the search page when online searches on health-related topics are made. India is the third country after Brazil and the United States where Google has launched this feature. The feature is also available in Hindi. The feature is live on Google app and search on Android, iOS, and desktop, tells users known symptoms, affected age group and other relevant information to a disease. Users can also download information in pdf for offline viewing.(Fig )
Fig 3.Google Health Search Launched in India in Feb 2016 on GOOGLE NOW ™
Main emphasis of this study on following points:
- value of patient Internet searches in medical practice.
- “Google search” using “Keywords” for ensuring valid Internet searches for health related topics, and
- measuring health literacy.
Aims&Objectives:Primary objective:
1.To assess the effects of “Google search” on patient knowledge and compliance.
2.To determine whether clinician can rely on internet for IEC activity.
Secondary Objectives:
1.Discuss advantages and disadvantages of patient Internet usage.
2.Recommend proper Internet utilization techniques in order to guide patients to reliable information. e.g. use accredited websites to search for healthcare information…
3.State the effect of patient Internet usage on health care.
Methods:
The study was approved by the hospital ethics committee. This study was conducted at a tertiary care eye hospitallocated at the junctionof the Indian states of Gujarat, Madhya Pradesh, and Rajasthan in western India
We have included patients having Incidental findings & chronic disease like glaucoma and diabetic retinopathy. Because in such cases, long term follow-up plus patient compliance and commitment is must for treatment success…
Study Design:Questionnaire study.
Sample size: 123 consecutive patients were enrolled for the study…
Inclusion criteria:
- Patients with Incidental Findings of glaucoma & diabetic retinopathy.
- Educated patient,
- having easy internet access,
- not previously counselled or treated.
Exclusion criteria:
- Illiterate patients
- No internet access or no basic computer operating knowledge.
- Not willing to participate in study.
A questionnaire was filled by patient. This is base score suggesting patient initial knowledge about his/her medical condition. We randomly divided patient into 2 groups.
1.counselling group.in which patient are given information by counsellor.
(gold-standard technique for patient education)
2.google search group. In which we provide them pre-tested “KEYWORDS” for “Google search’’& asked them to search only those keyword – study on internet.
On next visit, we gave same questionnaire to fill. Correct answer= +1 score & wrong answer =0.
Statistical analysis was performed using SPSS software.
QUESTIONAIRE: (fig. 4)
Fig 4. Questionnaire is used for the study
Example =>“key-words” & google results…
Glaucoma national eye institute – Glaucoma nei
Healthinfotranslations glaucoma hindi
Glaucoma guide RNIB (fig 5)
Glaucoma national eye institute – Glaucoma NEI (fig 6)
Statistical analysis was performed to compare pre and post Google search result.
123 consecutive patients included.
Mean total score before Google search 4.55* and maximum 6 in score range 0 to 6.
Mean total score after Google search 8.86 and maximum 9 in score range 4 to 9.
Statistically significant improvement in patient knowledge.
Table1.Score |
Mean |
Max |
Range |
Before Google Search |
4.55 |
6 |
0-6 |
After Google Search |
8.86 |
9 |
4-9 |
Table 2 TOTAL SCORE POST_TEST * TOTAL SCORE PRE_TEST Cross tabulation
| TOTAL SCORE PRE_TEST | |||||||||||
| TOTAL SCORE POST_TEST | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | Total | |
| 6 | 2 | 2 | 1 | 2 | 0 | 0 | 0 | 0 | 0 | 7 | |
| 7 | 0 | 2 | 1 | 0 | 1 | 3 | 2 | 0 | 0 | 9 | |
| 8 | 0 | 2 | 2 | 2 | 5 | 4 | 0 | 0 | 0 | 15 | |
| 9 | 2 | 4 | 4 | 12 | 7 | 21 | 1 | 2 | 1 | 54 | |
| 10 | 0 | 7 | 5 | 5 | 10 | 7 | 4 | 0 | 0 | 38 | |
| 4 | 17 | 13 | 21 | 23 | 35 | 7 | 2 | 1 | 123 | ||
Table 3 chi-square test for post-test result
Demographic Data:
Discussion:
“Patient education is a process of influencing behaviour rather than only giving information”
In above study 123 consecutive patients were enrolled for study. patients were having incidental findings of chronic disease like glaucoma & diabetic retinopathy. Such patients were first time diagnosed with disease and not previously treated or counselled.
We gave patient to choose between google (internet based) education learning or counsellor. Over half of the patients studied were willing to access the Internet for medical information, with younger patients more likely to undertake this activity. Patients from various socioeconomic strata and educational level were included. All were familiar with computer and internet. Moreover, a significant proportion of respondents were willing to undergo an Internet-based counselling in future.
An Internet-Google educational intervention is presented here as an alternative to gold-standard counsellor-patient education. primary reasonbeing, it would decrease counsellor workload, provide patients& their caretaker/relatives with increased access to information. other main aspects considered before intervention werelearning needs of the individual patient according to age, education level and socio-economic status.
In pre-test data, it showed that patients had poor knowledge regarding cause/risk factors of disease, available treatment options and necessity of life long follow-up.Highest improvement seen in those areas after google search seen in post-test data…
Percentage of improvement is variable among patients, but significant improvement in question no 6,7,8,9 which are related to treatment part of disease. Results are statistically significant and comparable with the improvement seen in control group which were counselled by trained counsellor and traditionally given information regarding disease.
Advantages associated with delivering health education through the internet
- low-cost mean of information and support to a large number of individuals
- the potential to reduce the financial cost of health education.
- anonymity of the Internet also allows individuals to obtain sensitive or embarrassing health information.
- tailored health information to be delivered to each individual, according to their health status and concern.
- It is self-learning by patient, does not affect by patient’s demographic profile.
Similar studies were conducted in western countries showing promising results.[1],[2],[3]Internet use can influence patient’s treatment decision, anxiety level, and understanding of their disease. Caregivers must recognize the growing trend of internet use and should counsel and educate their patients appropriately based on what they have read to help them accurately appreciate the nature of their disease.
The increased use of medical Web sites by patients raises important issues regarding the need for quality control, and impacts significantly upon the surgeon-patient relationship.
There are few limitations to above study. The above study used a small sample, NO follow-up, and there were no solid clinical-outcomes measures. Further research is needed utilizing larger samples over longer periods, controlled and randomized, in tandem with significant outcomes to support policy changes and buy-in efforts for implementation.
TakeHomeMessage:
- Internet is inevitable……
- So start using internet and modern technologies…
- Familiarize yourself with sites, which are dedicated to provide the quality of health information online.
- We should assist patients by acknowledging use of the internet and by serving as guides to help them find reliable material.
- As part of the medical history, routinely ask about use of the internet to obtain medical information.
- We should be prepared to offer suggestions for web-based health resources and to assist patients in evaluating the quality of medical information available on the world wide web.
Conclusion:
“Google search” provide positive impact on patient knowledge.
Internet seems feasible helping tool for InformationCounsellingEducation activity, but we must guide patients to use internet base medical information in proper way…for example by providing ‘key words’ in google search.
Future scope: further studies required with large number of patients, followup and various strategies (like interactive app/website) to improve usage of internet based medical information…
Reference:
1.Ullrich PF Jr, Vaccaro AR. Patient education on the internet: opportunities and pitfalls. Spine (Phila Pa 1976). 2002 Apr 1;27(7):E185-8.
2.Mo P (2012) The Use of Internet for Health Education. J Biosafety Health Educ1:e102.
3.Marissa N.Teaching Patients to Effectively Utilize the Internet for Healthcare Information. MedEdPORTAL Publications. 2014.https://www.mededportal.org/icollaborative/resource/2193
4.Runge, C., Lecheler, J., Horn, M., Tews, J-T., & Schaefer, M. (2006). Outcomes of a web-based patient education program for asthmatic.Chest, 129, 3, 581-593.
5.Scholten, R., Cousineau, T., Tuil, W., Samoocha, D., Bruinvels, D., Elbers, N. A., …van der Beek, A. J. (2010). Effectiveness of web-based interventions on patient empowerment: A systematic review and meta-analysis.Journal of Medical Internet Research, 12,
6.Webb, T. L., Joseph, J., Yardley, L., &Michie, S. (2010). Using the internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy.Journal of Medical Internet Research.
Figures
Fig.1. Google Homepage: Gateway for ocean of information.
Fig.2: How to search on Google. Search help by Google.
Fig 3.Google Health Search Launched in India in Feb 2016 on GOOGLE NOW ™
Glaucoma guide RNIB (fig 5)
Glaucoma national eye institute – Glaucoma
