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Introduction: While the Internet has the potential to empower patients to make better informed medical decisions, little is known about h ow patients search for health information. In this study, we characterize the online information seeking behavior of cancer patients and how it varies depending on literacy and education levels. Methods: We performed a prospective study of patients with newly diagnosed urologic cancer who were asked to complete three tasks: 1) a demographic survey, 2) the Wide Range Achievement Test (WRAT-4) Blue Word Reading list, used as a proxy for literacy, and 3) a five minute self-directed Internet search about their cancer. We used monitoring software to examine the type (e.g. advertisements, cancer-specific, etc.) and duration of websites visited during the Internet search. Results: Twenty-seven patients were enrolled. Among the seventeen patients who sought information from advertisement websites, 71% had below average WRAT-4 scores. Among the ten patients who sought information on non-advertisement websites, 80% had above average WRAT-4 scores. Of websites visited by those with only a high school education, 32.9% were advertisements. Alternatively, for those with at least a bachelor's degree, only 12.7% were advertisements. Conclusion: We demonstrated that patients with low literacy and education achievement more frequently sought information from advertisement-oriented websites compared to those with higher literacy and education. These findings should encourage physicians to guide patients towards appropriate high quality websites, particularly patients with low literacy and/or education levels.

The Influence of Literacy and Education on Online Health Information Seeking Behavior in Cancer Patients