American Journal of Health Studies - The Public’s Health Questions And What To Do About Them - Statistical Data Included
Abstract: People’s questions about health not only reveals their knowledge of medical concerns, but may also reflect on the adequacy of the health information system to provide answers. In this study we collected and analyzed 255 health questions from adults in a discount department store in a mid-sized town in middle America. Results suggest that large portions of the public do not know how to promote and maintain health and are looking for answers that the current health care system does not easily provide. This can be damaging to both health and the economy. This paper provides recommendations for how to improve the health information system based on an analysis of these questions.
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The adequacy of a health information system may be judged by the type of questions people ask. For example, if people do not know the answer to simple health questions or if they carry around unanswered questions, this may be evidence that the health information system is defective. In this study we sought to identify and analyze the unanswered health questions of adults and through this came to understand more about their health information needs and how to address them.
The health literature is thick with references that identify the public’s level of knowledge on specific health issues. For example, a Medline search on the medical subject heading “knowledge attitudes and practice” reveals over 8,000 entries related to health since 1981. For the most part, this literature is clinical and focuses on questions such as the patient’s level of knowledge of particular risks, conditions, and treatments. Other studies assess a community’s need for particular types of information, for example, about the causes of hypertension or asthma. Few studies, however, focus on the broader questions: What health questions do the public have? Where do they go for information? Do these questions and practices vary by demographics? Only one study in the recent health literature has sought to identify the type of questions people have - in this case, to ascertain the type of information needed for a local healthy living center (Winn & Bradford, 1991). Studies that seek to determine where people get health information are more common and have been used to assess the adequacy of these sources for meeting the health education needs of particular sub-populations (Arnold & Hom, 1996; Gollop, 1997; Richmond, McCracken, & Broad, 1996).
The current study identifies the health questions of adults and the sources of health information they use in a mid-sized town in south-central Indiana. This information was used to assess the adequacy of the health information system and to make recommendations to improve it.
METHODS
We set up a table in a discount department store on the fringe of a mid-sized town in Indiana (population 60,000) and offered to research answers to the health questions of adults. A store on the outskirts of the town was chosen to give us access to more of the rural population, which makes up a large portion of the population of southern Indiana.
While those who participated in the study were not chosen randomly, they may be more like the population of users of health information services. To use most health information services, a person must initiate an action to get an answer to their questions. Participants in this study had to approach a table and ask for help with a question. Participants in random surveys may not have taken an action on their own.
Participation was restricted to adults and each adult was allowed to ask one or two questions on any health topic. Health education students in training recorded the questions, researched the answers, wrote a response, and mailed the responses back to participants. In addition to the health questions, socio-demographic information was collected as well as responses to an open-ended question about where the participants go for health information.
RESULTS
Demographics
We collected 255 questions from 158 people (100 female and 58 male) within the space of 26 hours spread over a week. The sample size was limited by the students’ ability to write responses to each question - a process that occupied fifteen students a fair portion of the semester. The age range of participants was from 18 to 85 with a mean age of 38. Roughly half (54.9%) were under forty, about a third (34.6%) were between 40 and 59 and the rest were over 60. Most respondents were White (78.5%), with African-Americans making up 13.9% of the sample, Asians 5.7% and Hispanics 1.9%. Over half the sample (58.7%) had a household income below 25,000; only 14.7% had an income greater than $50,000. The sample approximated the demographics of the county which is 94% White with a median household income of $24,781. The adult population of the county is 53% female with 64.6% of adults being under 40 and. 21.1% between 40 and 60.
Question Type
Sixty-one percent of the sample asked more than one question. The questions were tremendously diverse, sorting into forty-two different categories - determined by major subject. For example, all questions on health care system were grouped together, and all questions related to diet were grouped together. Categorization was not always easy. In cases where the question could be fit into two categories, the question was placed into what was considered to be the narrower category. For example, a question about diet change to reduce the risk of heart disease was placed in the diet, not the heart disease category, as the diet questions were more similar in nature and less varied in scope than the heart disease questions. Many categories contained only a single question, for example, individuals wanted to know what is: cri du chat disease, celiac disease, the success rate for Islets of Langorhans transplantation, the latest research on Lopressor and Dilantin, and the latest research on Hereditary Hemorrhagic Telangiectasia. Table 1 lists the top ten most frequently asked question categories and the number of questions in each one. The categories with less than eight questions were collapsed into an “other” category.
