By Alexander J A M van Deursen, PhD; Jan A G M van Dijk, PhD
University of Twente, Department of Media, Communication and Organization, Enschede, Netherlands
Corresponding Author:
Alexander J A M van Deursen, PhD
University of Twente
Department of Media, Communication and Organization
Cubicus C1.47
PO Box 217
Enschede, 7500 AE
Netherlands
Phone: 31 534891021
Fax: 31 534894259
Email: a.j.a.m.vandeursen [at] utwente.nl
ABSTRACT
Background: Despite the amount of online health information, there are
several barriers that limit the Internet’s adoption as a source of health
information. One of these barriers is highlighted in conceptualizations of
the digital divide which include the differential possession of Internet skills,
or “eHealth literacy”. Most measures of Internet skills among populations
at large use self-assessments. The research discussed here applies a
multifaceted definition of Internet skills and uses actual performance tests.
Objective: The purpose of this study was to assess how ready a sample
of the general population is for eHealth. More specifically, four types of
Internet skills were measured in a performance test in which subjects
had to complete health-related assignments on the Internet.
Methods: From November 1, 2009, through February 28, 2010, 88 subjects
participated in the study. Subjects were randomly selected from a telephone
directory. A selective quota sample was used divided over equal
subsamples of gender, age, and education. Each subject had to accomplish
assignments on the Internet. The Internet skills accounted for were
categorized as operational (basic skills to use the Internet), formal
(navigation and orientation), information (finding information), and strategic
(using the information for personal benefits). The tests took approximately
1.5 hours and were conducted in a University office, making the setting
equally new for all. Successful completion and time spent on the
assignments—the two main outcomes—were directly measured by the test
leader.
Results: The subjects successfully completed an average of 73% (5.8/8) of
the operational Internet skill tasks and an average of 73% (2.9/4) of the
formal Internet skill tasks. Of the information Internet skills tasks, an average
of 50% (1.5/3) was completed successfully and, of the strategic Internet skills
tasks, 35% (0.7/2). Only 28% (25/88) of the subjects were able to successfully
complete all operational skills tasks, 39% (34/88), all formal skills tasks,
13% (11/88), all information skills tasks, and 20% (18/88), both the strategic
skill tasks. The time spent on the assignments varied substantially. Age and
education were the most important contributors to the operational and formal
Internet skills. Regarding the formal Internet skills, years of Internet experience
also had some influence. Educational level of attainment was the most
important contributor to the information and strategic Internet skills.
Conclusions: Although the amount of online health-related information and
services is consistently growing, it appears that the general population lacks
the skills to keep up. Most problematic appear to be the lack of information and
strategic Internet skills, which, in the context of health, are very important. The
lack of these skills is also problematic for members of younger generations,
who are often considered skilled Internet users. This primarily seems to
account for the operational and formal Internet skills. The results of the study
strongly call for policies to increase the level of Internet skills.
(J Med Internet Res 2011;13(2):e35)
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