Internet Usage among Pregnant Women for Seeking Health Information: A Review Article.

BACKGROUND: In recent years, the Internet has become one of the most popular sources of health information for users, and pregnant women are no exception. This study aimed to investigate Internet usage among pregnant women for achieving health information on the finding of related studies.
MATERIALS AND METHODS: This review study was conducted by searching databases such as IranMedex, Magiran, Scientific Information Database, Irandoc, PubMed, Science Direct, Cochrane, Google Scholar, and Scopus in December 2016. Restrictions were placed on publication to within 16 years and language of publication was restricted to English and Persian. Keywords used in the search included information-seeking behavior, information-seeking, information needs, access to information, pregnancy, and pregnant women.
RESULTS: This search resulted in 106 related publications and among them sixteen articles met inclusion criteria. This review showed that the use of the Internet by pregnant women was driven by information needs, ease, and speed of access and finding people with the same situation. Fetal development, symptoms, and complications of pregnancy, prenatal tests and nutrition, activities during pregnancy, and stages of delivery were the most often mentioned topics of interest. The benefits of internet use include reduced anxiety, personal support, creating an emotional connection and an increased confidence.
CONCLUSIONS: Health providers must have sufficient ability for interpreting the achieved information from the Internet and should allocate efficient amount of time for discussing information-seeking manners with pregnant women. Furthermore, they must try to respond to the doubts of pregnant women and provide valid and reliable online educational resources.

Introduction

Pregnancy is one of the most important periods in a woman's life. Pregnancy is associated with physical changes; however, health-related decisions during pregnancy are essential and might affect the life of the mother and her unborn child. Pregnant mothers require health-related information to secure their health and have a healthy delivery,[1] because this information will enable women to recognize and reduce pregnancy complications such as iron deficiency anemia and also to perform preventive health behaviors such as increased consumption of folic acid and iron during pregnancy, appropriate weight gain, and improved neonatal birth weight.[2]

Evidence suggests that appropriate health information and advice provided to women before and during pregnancy can significantly reduce the rate of caesarean section.[34] Furthermore, health information has significant effects on reducing maternal and infant mortality rate,[56] and could also improve the sexual performance of the couples.[7] In recent years, the Internet has become a popular source of health information among pregnant women.[89] Publication of health information on the web is a new phenomenon and its accessibility and low costs have made it a popular media.[1011] A study that was conducted in Sweden reported that 84% of women were using Internet as the source of their health information during pregnancy.[12] Searching the Internet is conducted in wide scales but one of the problems and challenges for the users is inability to judge about quality and accuracy of the found data about medical recommendations and consultations.[13] Although women perceive the information they read to be reliable, much of what is on the Internet is outdated or even erroneous.[14] Studies have shown that mothers usually do not discuss using Internet with their healthcare providers and care givers are usually not aware of the potentially wrong information and incorrect beliefs that mothers can achieve.[15] Considering all the mentioned matters and their importance, the present study was conducted to determine the condition of Internet usage among pregnant women for achieving health information.

Materials and Methods

In the present review article, to achieve the intended information, the abstracts, titles, and keywords of published articles in national Persian journals, databases for registry of clinical trials, Scientific Information Database (SID), Iranian Medical Articles database (IranMedex), Iranian Research Institute for Information Science and Technology (Irandoc), and Iranian Magazines Database (Magiran) were searched using general keywords including “information searching behaviors”, “searching for information”, “informational needs”, “achieving information”, “pregnancy”, and “pregnant women”. For English databases such as Science Direct, Google Scholar, Scopus, Cochrane and PubMed, English and Mesh equivalent of the words including “informational needs”, “access to information”, “information sources”, “seeking information”, and “health information-seeking behaviors” were searched. This search resulted in achieving 56 published articles in PubMed database, 35 articles in Google Scholar, 12 articles in Science Direct, 1 article in Cochrane, 6 articles in Magiran, and 2 articles in Irandoc; after finding the common articles between the databases; a total of 106 articles were retrieved.

After preparing a primary list of the articles, their titles were checked by two members of the research team and the repeated tiles were eliminated. Then, the title and abstract of the remaining articles were carefully reviewed and ineligible articles were removed from the list. Then, the full texts of the remaining articles were reviewed and eligible articles were selected for the study. The following data were extracted from all included studies: Title, author, and date of study; Details of the study including aim, design, participant recruitment and research ethics; Results and limitations of study. Finally, selected articles were evaluated to determine the rate of Internet usage by pregnant women, its causes, advantages, and disadvantages of using the Internet and also the searched subject on the Internet. Related words to health information-seeking were combined with related words to Internet and pregnancy using “and” operator.

The inclusion criteria for the articles were: being published from January 1, 2000 to December 20, 2016, being related to Internet usage among pregnant women or its related topics, and being published in English or Farsi languages. The exclusion criteria for the articles were: being presented at seminars and conferences, being a review article, case report or letter to editor and inaccessibility to the full texts of the articles.

Ethical considerations

Research ethics confirmation (ethical approval code: IR.MUI.REC.1395.3.955) was received from the ethics committee of Isfahan University of Medical Sciences.

Results

Study selection outcome

In reviewing the studies, from a total of 106 articles found in the primary search, 16 were selected for final evaluation; from them 13 were qualitative studies and 3 were quantitative studies. Results of the study fell under five main themes, including (1) The rate of Internet usage by pregnant women, (2) The time to start Internet searching, (3) The reasons for searching the Internet, (4) Women's perceptions of the usefulness and faults of retrieved health information, and (5) Type of information sought. These five main themes are described below.

The rate of Internet usage by pregnant women

Reviewing these studies showed that the rate of Internet usage among pregnant women for achieving health information varied between 28 to 95%[1617] and it has specifically increased during the recent years. In Italy and Sweden 95%,[1516] in Canada 93.50%,[18] and in China 88.70%[8] of pregnant women were using Internet for acquiring health information.

The time to start Internet searching

Reviewing the studies revealed that 81.50% of women from the first trimester, 13.50% from the second trimester, and 5.10% from the third trimester started to search the Internet.[8]

The reasons for searching the Internet

The specific reasons that women reported for using the Internet varied widely. It included the need for more information, the ease and speed of access,[15] and finding people in similar situation.[16]

Women's perceptions of the usefulness and faults of retrieved health information

One of the notable results of the present study was the benefits of using the Internet among pregnant women. Studies showed that achieved information from the Internet could decrease the concerns and fears of the unknown events in pregnant mothers and help them to making decisions about their pregnancy after Internet usage.[1519] Results also showed that the Internet could be used to achieve personal and virtual support for pregnant mothers.[20] Creating emotional relations, reduced anxiety, encouragement, and taking positive energy from each other in online forums could increase the self-esteem of pregnant mothers.[21] In the reviewed studies, despite the mentioned advantages of Internet usage, mothers were concerned about unreliability of the provided health information on the Internet.[19] However, one study showed that most of the pregnant mothers (70%) did not discuss the achieved information from the Internet with their midwives.[22]

Type of information sought

The most often mentioned topics of interest included fetal development,[821] symptoms and complications of pregnancy,[8] activities during pregnancy,[23] nutrition during pregnancy,[8] and stages of delivery and birth giving.[2122] A summary of the results is shown in Table 1.

Table 1

Studies on using the Internet to achieve health information among pregnant women from 2000 to 2016

Discussion

Nowadays websites are one of the main channels for gaining information, and pregnant women are some of the most active users of health information.[19] The present article is a review of published studies in the field of Internet usage by pregnant women for achieving health information during the past 16 years (from 2000 to 2016) and eventually, has reported the results of 16 qualitative and quantitative studies that has been published in Farsi and English languages.

This review aimed to discover how often pregnant women searched the Internet, the reasons for searching the Internet, the type of information they sought and their perceptions of the usefulness and faults of retrieved health information. Results of this review indicated that most of the pregnant women have used the Internet to gain health information, in recent years [151619] and they most often used the Internet during the early stages of pregnancy.[8]

According to the results of the studies the increase in the use of Internet during recent years has been due to the abundance of online resources of information,[28] online (web-based) health programs,[29] and helping in and facilitating the process of decision making for people.[30] Based on the results of this review, Internet has an important role in seeking information early in pregnancy about fetal development, which will lead to improved confidence and have an impact on mothers decision making; therefore, it is necessary for healthcare providers to have complete access to valid and evidence-based information for interpreting the information that has been achieved by the mothers from the Internet. This issue must be considered during educational courses.

Also, reviewing the studies revealed that most of the mothers have not discussed the information obtained from the Internet with their healthcare providers.[22] Sayakhot and Carolan-Olah in their systematic review that was titled “Internet use by pregnant women seeking pregnancy related information” in 2014 reviewed published articles during 10 years (from 2004 to 2014) and eventually reported the results of 7 English language quantitative studies. These researchers also resulted that most of the pregnant women would not discuss the achieved information from Internet with their health providers.[13] It seems that, considering the healthcare providers' unawareness of the wrong achieved information and incorrect beliefs of the mothers; it is necessary for the healthcare providers to allocate a time for discussing information-seeking and the searched topics on the Internet with pregnant women. They should warn the mothers about the wrong and confusing information on the Internet and be able to provide correct information to them.

Reviewing the studies showed that pregnant mothers searched the Internet to resolve their informational needs [8192123] and most of the mothers were not satisfied with provided information from the care givers. The mentioned reason for using the Internet by the mothers was healthcare providers' lack of time to provide information for the mothers.[9] Hardy in his study mentioned that the mean time that the physicians spent with the patients is very limited, and patients have stated that they need more information than what the physicians are presenting to them.[31] Therefore, unanswered questions could be one of the reasons for searching other information resources such as the Internet.[32]

The increase in using the Internet as a resource for searching health information have increased the concerns about its potential effects on the relation between the patient and the care giver,[3334] as well as about patients' ability for assessing and evaluating the validity of these resources.[35] Considering the present results, and since healthcare providers are not able to provide every piece of information to the pregnant mothers, Internet could be considered a valuable source of information that would allow the mother and the physician to spend their limited time together discussing more important issues and prevent repeated visits for concerns about small issues. But, considering mothers' inability to asses and evaluate the validity of online sources, it is necessary for the care givers to get familiar with valid websites so that they would be able to introduce them to their patients. Furthermore, it is necessary for them to design valid websites according to the needs of pregnant mothers, and guide mothers toward finding high-quality online information. It must be noted that lack of access to some of the databases and the full text of some of the articles was the most important limitation of the present study.

Conclusion

Results of the present review study revealed that most of the women would use the Internet for receiving health information during their pregnancy. Information achieved from the Internet might decrease the concerns of pregnant women and their fear of the unknown events. It might also help them make decisions about their pregnancy. Most of the mothers would not discuss the achieved information from the Internet with their healthcare providers. Therefore, healthcare providers should be aware of this issue and allocate an efficient amount of time for discussing information-seeking on the Internet with pregnant women. They also should have sufficient ability in interpreting the achieved information from the Internet.

Financial support and sponsorship

Isfahan University of Medical Sciences.

Conflicts of interest

Nothing to declare.