Author Email: [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected].

Correspondence: Morufu Olalekan Raimi, [email protected] 

Abstract

Seeking health information on the internet has become wide spread among people of young age especially because of the infiltration and advancement of ICT in Sub-Saharan Africa, though only few studies have examined these developments. Most literatures on the use of the internet for seeking health related information is largely concentrated on developed countries. This study determined the prevalence, determinants and benefits of internet use for health-related information among adults in Abuja, Nigeria. A cross-sectional descriptive study was adopted to achieve the objectives of the study from a sample of 355 respondents. Data was collected through the use of a structured questionnaire and it was analysed with the use of SPSS version 23.0. Findings indicate that the prevalence of internet use for health-related purposes by adults in Abuja, Nigeria, was 81.4%. The frequency of use of the internet for health purposes was reported to be everyday by more than half (54%) of the adults in Abuja, Nigeria. The use of the internet for health-related purposes was found to be influenced by the age, religion and educational status of the respondents (P = 0.004, 0.002 and 0.002 respectively). The knowledge of the use of internet for health-related purposes by adults in Abuja, Nigeria, was high (95.1%). Almost all (97.7%) of the respondents knew the correct description of internet services and the major device that was used to access the internet were mainly iPhone android (43.1%), phone (24.0%) and laptop (20.0%). The most reported factors influencing the use of the internet for health-related issues by the adults in Abuja, Nigeria, were dealing with health issues (34.6%), lack of funds to pay for healthcare service (29.1%), to maintain privacy (22.0%) and too busy to visit a hospital (19.1%). Increased knowledge on health topics, informed decision-making (39.7%), improve doctor-patient relationship (37.1%) and compliance with medication (23.4%) were identified as the major benefits associated with the use of the internet for health-related purposes (62.3%). The prevalence of internet use for health-related information among adults in Abuja, Nigeria, was high. However, it was significantly influenced by the age, religion and educational status of the respondents. Thus, there is need to promote e-health in the country as a viable platform for health interventions and healthcare. This would ease the pressure and congestion that characterize physical healthcare services in the country, leading to overall improvement in healthcare delivery. There is also need for a thorough evaluation of the various websites, apps, and platforms that are health related, so that those that are not health-enhancing could be avoided.

Keywords: Prevalence, Determinants, Benefits, Internet, Health.

Introduction 

For every society, good health is one of the basic necessities of individuals who live therein as it has a great influence on an individual’s productivity, earning capacity, educational performance, happiness and longevity of life [1-8]. Health is directly affected by people’s personal circumstances, physical environment, social conditions and the home neighborhood [4-7, 9]. Since the inception of the internet, it has rapidly become the single largest source of information globally [10-12]. With the advent of this technology, health information has witnessed an exponential increase in accessibility [11, 12]. There has been a rapid growth on Interest in the Internet as a communication tool for health-related information [13]. The Internet is an effective and efficient global network which enables global communication via computers and other communication gadgets such as phones. The Internet is defined as a global broadcasting capability, a system for information broadcasting and a means for interaction between individuals through their devices irrespective of their geographical locations [14]. More people in Africa currently have access to the internet than they do to quality healthcare services [3-6], clean water or even good sanitation [15-22]. This can be traced to the increasing number of telecommunication companies within the African region with lots of enticing packages including internet services. Patients’ knowledge and engagement in health decision making strategies has improved as a result of seeking health information on the internet [23]. This has also had a positive effect in doctor-patient interactions at the clinic. Also, patient-centered websites, blogs and other platforms give room for patients to share their personal experiences regarding their health or certain disease conditions thereby offering special insights on some health matters that physicians may not readily provide [24]. This act of seeking health information from the internet helps to improve social interactions, physical wellbeing, lifestyle, better coping with life situations, nutrition, emotional relief as well as effective clinical outcomes [25].

Across the African continent, new and innovative ways to ensure that basic healthcare is available to all is tirelessly been researched by both government and stakeholders. Seeking health information on the internet has become wide spread among people of young age especially because of the infiltration and advancement of ICT in Sub-Saharan Africa, though only few studies have examined these developments. Most literatures on the use of the internet for seeking health related information is largely concentrated on developed countries [26-28]. Seeking health information online comes with some benefits and shortcomings. Some of these benefits include access to wide range or knowledge and information on different health topics as well as disease conditions that could be relevant in increasing the involvements in doctor-patient interactions, informed decision making and compliance with medications [29]. The major challenge associated with accessing health information from the internet range from quality to trustworthiness of the enormous volumes of health information found on various platforms on the internet [30].

Despite the evident infiltration of ICT in Sub-Saharan Africa, especially among the youth, not many studies have explored the use of the internet for health-related purposes. Previous studies in this area have largely concentrated on developed countries like UK and America. There are few studies on the use of internet for health purpose in Nigeria that focuses on youths in general. Most studies in Nigeria focus on tertiary institutions and are narrowed to the use of internet for health purpose by specific population. It is thus not clear how youths in Nigeria which are an important segment of the population, with wide access to modern information technologies use the internet for health-related purpose [10]. 

Available evidence indicates that access to the Internet is increasing among tertiary institution students in Nigeria. These studies focused more on tertiary institutions in Nigeria. Therefore, this current study seeks to contribute to literature by assessing the prevalence, determinants and benefits of the use of internet for health-related information among adults in Abuja. Abuja has a large population of adults who are internet savvy. The city has good internet network, with a number of network providers; this among other factors has contributed to the choice of carrying out the study in Abuja. It is hoped that this study will give way to further studies on quality and trustworthiness of health information accessed on the internet and also provide approaches and strategies that both the government and stakeholders in the healthcare delivery system can maximize to ensure quality health information on all platforms on the internet. Thus, this study will also serve as a source of reference in this area of research for future studies/researchers.

Methodology

Study Area

Abuja also known as the Federal Capital Territory (FCT) is Nigeria’s capital city. Abuja was created in 1976 and located on the North of the confluence of the Niger and Benue rivers. It is bordered by the following states; Niger to the West and Northwest, Kaduna to the Northeast, Nasarawa to the East and South, and Kogi to the Southwest. Abuja covers a land area of 1769km2 (683 sq mi), stretching between coordinates 8o50’N 7o10’E with an elevation of 840 meters above the sea level. Time Zone is UTC +1. At the City’s Central Area are the Three Arms Zone (which is home to the Presidential palace), the National Arboretum, the National Christian Centre, the National Mosque, Millennium Park and the National Stadium (a large multisport arena) on the Western edge of the Central Area. Abuja also have an International Airport (Nnamdi Azikiwe International Airport) and expressways connecting the Federal Capital Territory with other cities. Abuja is Nigeria’s Administrative and Political center and also a key Capital on the Africa continent because of Nigeria’s geo-political influence in regional affairs. Abuja as a conference centre hosts various meetings, such as the 2003 Commonwealth Heads of Government meeting and the 2014 World Economic Forum (Africa) meetings [31, 32]. Abuja had a population of 1,814,000 as at the 2010 with 6.14% growth rate. In 2015, the population increased to about 2,442,000 with a growth rate of 6.13%. And in 2020, the population count increased to 3,278,000 with about 5.91% growth rate. Between 2010 and 2015, the population figures showed a growth in population by about 36.77%; and between 2010 and 2020 the population growth rate has greatly increased to 67.10% within a period of 10years, making it one of the fastest growing cities in Nigeria and Africa at large [31, 32].

Study Population

For the purpose of this research the study population is comprised of adults (18 years and above) dwelling in the capital city of Abuja. 

Inclusion Criteria 

The study includes adults who are 18 years and above who reside in Abuja, Nigeria within the period of data collection.

Exclusion Criteria

Adult residents of Abuja 18years and above who decline participation. Also, adults 18 years and above, who are ill or have other underlying medical or surgical conditions that might not allow them participate in the survey. 

Study Design

The study design adopted is a cross-sectional descriptive study which was carried out among adults in Abuja. It is hoped that this technique will enable this research to obtain detailed information on adults’ use of the internet for health purposes.

Sample Size Determination 

The sample size in this study was determined using single population proportion formula. Sample size determination was based on 67.7% prevalence rate from a previous study [33, 34] using a marginal error of 5% critical value with a confidence interval of 95% and a non-completion rate of 10% using Cochran equation for sample size determination.

  n = Z2pq/d

  Where;
    n = sample size for the target population
    Z = the standard normal deviation corresponding to 95% level of significance (1.96)
     p = prevalence rate of 67.7% (0.677)
     q = 1 - p
      q = 1 - 0.677
      q = 0.323
      d= degree of precision set at 5% (0.05)

       Therefore, n = (1.96)2 × 0.677 × 0.323
             (0.05)2
                 n =   0.8400
                        0.0025
                   n = 336.02

   Allowance of about 10% was made for non-completion rate = 10/100 × 336

                    = 0.1 × 336
                    =33.6
                     = 34

Therefore, the sample size (n) = 336 + 34 = 370

Hence, the minimum sample size will be approximately 370 adults residing in Abuja, Nigeria.

Sampling Technique

The participants used for the study were selected using multi-stage sampling technique.

Stage1: Out of the six Area councils in Abuja, Abuja municipal was selected using simple random sampling.

Stage 2: In Abuja municipal Gwarimpa was selected using simple random sampling

Stage 3: First, third and sixth avenue was selected using random sampling in Gwarimpa

Stage 4: Participants in the study were selected using convenience sampling. In the households, the head of the family is interviewed or anyone 18 years and above why in business centers the owner of the business is interviewed or any employee 18 years and above. Any person 18 years and above who agrees to participate in the survey in both the households and business centers is given questionnaire and guided on how to fill the questionnaire.

Study Instruments

The tool used for data collection was a well-structured close-ended questionnaire which was validated by testing on some adults before administration to the study participants. Data was gathered from participants who consented to the study. The data gathered was from the various sections of the questionnaire divided into A - socio-demographic data, B – number of people that use the internet for health-related purposes, C – factors affecting the use of internet for health-related purposes and D – benefits of the use of internet for health-related purposes.

Data Collection Methods

The questionnaire was self-administered, although under direct observation to ensure completion. Participants were assisted by some research assistants who had been trained and briefed on the process, procedures, techniques, and means of data collection.

Data Entry and Analysis

To analyze the data gathered, Statistical Package for Social Sciences (SPSS) version 23 was used to conduct an analysis for the different variables. Descriptive Statistics such as frequency and percentages, was used to categorize and summarize the social demographic variables. Chi-square test and regression analysis was used to test the relationship between age and the use of the internet for health-related information.

Ethical Clearance

Ethical approval was obtained from the Ethical Committee of Faculty of Medical Sciences University of Nigeria Nsukka. High level of confidentiality of the participants was ensured and maintained. The data collectors explained the target and purpose of the study to the participants and also informed them that the information collected will strictly be used for research purposes only. Informed consent was also obtained from every participant after the purpose and procedure of the study was also explained to each participant. Meanwhile, no participant was unduly influenced, forced or coerced to participate or continue to participate in the study. Participants were also informed of their freedom to withdraw from the study at any point in spite of their initial consent to carry on. The participants were assured of the confidentiality of any and all information received. To further assure anonymity, the name and contact details of the participants was not requested. 

Limitation of the Study

Participants may not be completely sincere with their responses to the use of internet for health-related purposes for fear of being criticized.

Implication of the Study

The study will help the government agencies responsible for regulation of internet services to monitor and regulate the content of health information made available online as well as educate and encourage the public especially adults on the benefits of using the internet for health-related purposes.

Results 

Data collected were sorted, presented and analyzed. All data were collected using a questionnaire. Of the 370 (100%) questionnaires that were administered, 350 (94.59%) was appropriately filled and returned and used for the study; whereas 20 (5.40%) questionnaires were not returned and therefore not included in the study.

Table 1: Socio-demographic Characteristics of Respondents (n = 350)

Table 1 revealed the socio-demographic characteristics of the respondents. Findings indicate that more than half (59.7%) were males while their mean age was 35 (SD ± 10). More than half (62.2%) were Christians and a greater proportion (56.0%) had tertiary education. Those who were students, unemployed and traders were the majority (31.7%, 26.3% and 24.0% respectively).

 Table 2: Frequency of the Use of Internet among the Respondents (n = 350)

* Multiple responses applicable 

Table 2 revealed the frequency of use of the internet among the respondents. Findings showed that a greater proportion (95.1%) had heard of internet services. Majority (97.7%) knew internet services as a system of global communication while a greater proportion (92.6%) opined that they had access to internet services. More than half (88.6%) opined that they had used internet services in the past weeks. The major device used were iPhone android (43.1%), phone (24.0%) and laptop (20.0%). Less than half (44.6%) stated that they used the internet every day.

Table 3: Knowledge of use of internet for health purpose among the respondents (n = 350)

* Multiple responses inclusive; a - others such as hip enlargement, drug reaction, Enhancements and facials, amongst others.

Table 3 revealed the use of the internet for health purpose among the respondents. Findings indicate that the respondents used the internet mainly for news and sport (54.3%), entertainment (41.7%), education (40.0%) and health (36.9%). A greater proportion (81.4%) had used the internet for health purpose. The major topics that are searched for on health was sex/reproductive health (44.7%), diet (35.4%) and fitness/exercise (31.1%). The major sites used for search for health topics were social media (56.6%), educational websites (54.0%) and individual websites (38.9%). Information from self (76.0%), family members (54.0%) and from friends were the major source of information for the respondents. 

Table 4:  Factors that Determine Use of Internet for Health Purpose (n = 350)

          * Multiple responses applicable

Table 4 showed the perceived factors that determined the use of the internet for health purpose. The highest-ranking factors were helping another deal with health issues (34.6%), lack of funds to pay for healthcare service (29.1%), to maintain privacy (22.0%) and too busy to visit a hospital (19.1%).

Table 5: Benefits of the Use of Internet for Health Purpose (n = 350)

                    * Multiple responses applicable

Table 5 showed the respondents’ perception of the benefits of the use of the internet for health purpose. More than half (67.7%) stated that the internet was useful for health and less than half (45.4%) stated it was very helpful. More than two third (68.9%) used the information obtained from the internet for solving their health problem. More than a third (36.6%) reported experiencing an incident of misleading information and the site where the misleading information was obtained were social media (69.5%) and educational websites (49.2%). Wrong prescription (60.2%), hospitalization (41.4%) and drug reaction (22.7%) were mentioned as the major effects of the misleading health information.

Table 6: Perceived Benefits of the Use of Internet for Health Purpose among the respondents (n = 350)

* Multiple responses inclusive; a - others such as hip enlargement, drug reaction, enhancements and facials, amongst others.

Table 6 showed the perceived benefits of the use of the internet for health purpose among the respondents. The major health topics searched for by the respondents were sex/reproductive health (44.7%), diet (35.4%) and fitness/exercise. The major benefits of health information were increased knowledge on health topics (62.3%) and informed decision-making (39.7%). Lack of internet device (61.4%), high cost of internet data subscription (56.0%), inability to read (24.0%) and poor internet connectivity (20.6%) were identified as major barriers to the use of the internet for health purposes.

Table 7: Association between the Socio-demographic Characteristics of the Respondents and their Use of the Internet for Health Purpose (n = 350) 

Table 7 revealed that there was significant association between the age, religion and educational status of the respondents and their use of the internet for health purposes (P < 0.05).

Discussion

The study established that the prevalence of internet use for health-related purposes by adults in Abuja, Nigeria, was 81.4%. The findings in this present study are similar to the trend of use established in previous studies globally as well as in Nigeria. However, the prevalence of use of the internet for health-related purposes in this study is higher than that of Onyi and Rebecca in Bauchi as well as that of Obasola and Agunbiade [35, 36]. The proportion of internet use in this present study is commendable and suggests that there is a growing interest in the use of the internet as a communication tool for health-related purposes in Nigeria [37, 38]. The frequency of use of the internet for health purposes was reported to be everyday by more than half (54%) of the adults in Abuja, Nigeria. Again, the frequency of the use of the internet for health-related purposes in this present study is slightly higher than other previous studies that was carried out in Nigeria [39, 40]. For instance, a study among undergraduates in a Nigeria university had previously reported a daily use of 33.7%. The variation in both studies could be linked to difference in geographical settings as well as characteristics of the study population [36]. Additionally, greater proportion of the respondents were found to use social media (56.6%) and educational websites (54.0%) for their search for health-related topics on the internet. These finding seem to suggest that the respondents in this present study obtained information on health-related topics from several sources. A major reason for the increasing use of the internet for health-related purposes as shown in this study could be linked to the availability of personal computer system and mobile phones with Internet facilities in Nigeria [10, 39, 40].  Impliedly, it could be argued that the prevalence of use of the internet for health-related purposes among the respondents in this study could have positive impact on the knowledge base of the respondents as opined in a study that was carried out in Nigeria by Benson et al, [39].

Several health-related topics were reported to be searched for by the respondents in this present study. The most reported health-related topics that were searched for by the respondents in this present study were information on sex/reproductive health (44.7%), diet (35.4%) and fitness/exercise (31.1%). These findings seem to suggest that the internet provide numerous benefits to the user especially with respect to exposure to a wide range of knowledge and information on different health topics as well as disease conditions that could be relevant in increasing the involvements in doctor-patient interactions, informed decision making and compliance with medications [29]. Similar observations were also made in the other previous studies in Nigeria [41-46].

The use of the internet for health-related purposes was found to be influenced by the socio-demographic characteristics of the adults in Abuja, Nigeria. Specifically, age, religion and educational status of the respondents was found to influence their use of the internet for health purposes (P = 0.004, 0.002 and 0.002 respectively). In this present study, those within the ages of 39 – 45 years were found to use the internet for health purposes than those who were older (94.3% and 73.3% respectively) while Christians were found to use the internet than Muslims (84.9% and 71.3% respectively). Highest use of the internet for health-related purposes was observed among respondents with higher levels of education than those with lower forms of education (90.8% and 64.7% respectively). The influence of the aforementioned socio-demographic characteristics was also mentioned in the study of Cotton and Gupta [45] who stated that that online health information seekers have socio-demographic and health related characteristics of which people of middle age tend to use the internet more to seek for information concerning their health more than the older-aged people; and also that more educated people with internet knowledge and skills tend to use the internet to obtain information about their health or those of their loved ones [46, 47]. These findings also agree with assertions from previous studies [26, 47, 48]. 

The findings of this present study also indicate that the knowledge of the use of internet for health-related purposes by adults in Abuja, Nigeria, was high (95.1%). Almost all (97.7%) of the adults knew the correct description of internet services and the major device that was used to access the internet were mainly iPhone android (43.1%), phone (24.0%) and laptop (20.0%). Again, this finding seems to corroborate the assertion in a previous study which revealed that patients’ knowledge and engagement in health decision making strategies has improved as a result of seeking health information on the internet [23]. Possible reason for the increasing knowledge of the use of the internet for health-related purpose in this present study could be linked to the opinion that the act of seeking health information from the internet helps to improve social interactions, physical wellbeing, lifestyle, better coping with life situations, nutrition, emotional relief as well as effective clinical outcomes [49-56].

Several factors were reported to influence the use of the internet for health-related issues by the adults in Abuja, Nigeria. The most reported factor that was revealed by majority of the respondents in this present study was to deal with health issues (34.6%). This finding is consistent with the finding in the study of Berger et al. [48]. Other factors that were mentioned include lack of funds to pay for healthcare service (29.1%), to maintain privacy (22.0%) and too busy to visit a hospital (19.1%). These findings suggest that the respondents in this present study were mainly influenced by the ease, availability and convenience of using of the internet for health-related purposes. Similar assertions have been reported in other studies in Nigeria as well as in other countries [10, 39, 40].

These were observed to be varying perception of the benefits of the use of the internet for health-related purposes among the respondents in this present study. For instance, the proportion of respondents who opined that the internet was useful for health-related purposes were 67.7%. Some of the major health topics that were searched for by the respondents in this present study were topics related to sex/reproductive health (44.7%), diet (35.4%) and fitness/exercise (31.1%). These findings are almost similar to the findings in the study of Obasola and Agunbiade among undergraduates in Nigeria as well as some other studies that were conducted in Ghana [36, 40-43]. Increased knowledge on health topics was identified by the respondents in this present study to be a major benefit associated with the use of the internet for health-related purposes (62.3%). Other benefits that were identified include informed decision-making (39.7%), improve doctor-patient relationship (37.1%) and compliance with medication (23.4%). These findings have also been mentioned in previous studies [29, 57, 58]. Considerably, it could be suggested from these findings that seeking health information online comes with some benefits.

However, further findings from the study revealed that more than one-third (36.6%) of the adults in Abuja, Nigeria, had experienced an incident of misleading information owing to their use of the internet for health-related purposes. Several platforms on the internet were identified to be the source of the misleading information obtained by the respondents in this present study. The most commonly reported ones were social media (69.5%) and educational websites (49.2%). Impliedly, these findings suggest that seeking health information online comes with some benefits and shortcomings. Similar assertions were reported in a previous study where it was revealed the major challenge associated with accessing health information from the internet range from quality to trustworthiness of the enormous volumes of health information found on various platforms on the internet [30]. These findings are also consistent with that of Lemire et al. [59] in 2008.

The study also identified negative and serious concerns associated with the effect of obtaining misleading information from the internet in this present study. The most reported effect that was reported by majority of the respondents in this present study was wrong prescription (60.2%). Other negative effects associated with the use of the internet was hospitalization (41.4%) and drug reaction (22.7%). These findings are consistent with the findings in previous study where it was revealed that there are also disadvantages associated with the use of the internet for seeking health information. Similar assertion has also been mentioned in previous studies that were carried out in Nigeria as well as globally [10, 37, 38]. The findings in this present study seem to suggest that it is necessary to investigate the sources of access, trustworthiness, and decisions associated with accessed health information on the internet.

Conclusion

The study determined the prevalence, determinants and benefits of internet use for health-related information among adults in Abuja. The major findings of the study are:

1. The prevalence of internet use for health-related purposes by adults in Abuja, Nigeria, was 81.4%. The frequency of use of the internet for health purposes was reported to be everyday by more than half (54%) of the adults in Abuja, Nigeria

2. The use of the internet for health-related purposes was found to be influenced by the age, religion and educational status of the respondents (P = 0.004, 0.002 and 0.002 respectively). 

3. The knowledge of the use of internet for health-related purposes by adults in Abuja, Nigeria, was high (95.1%). Almost all (97.7%) of the respondents knew the correct description of internet services and the major device that was used to access the internet were mainly iPhone android (43.1%), phone (24.0%) and laptop (20.0%).

4. The most reported factors influencing the use of the internet for health-related issues by the adults in Abuja, Nigeria, were dealing with health issues (34.6%), lack of funds to pay for healthcare service (29.1%), to maintain privacy (22.0%) and too busy to visit a hospital (19.1%).

5. Increased knowledge on health topics, informed decision-making (39.7%), improve doctor-patient relationship (37.1%) and compliance with medication (23.4%) were identified as the major benefits associated with the use of the internet for health-related purposes (62.3%). 

Recommendations

Based on the findings of this study, the following recommendations will suffice:

1. The Internet is assuming an important role in the lives of the people in Nigeria as it is also being used for life-supporting and sustaining purposes including searching for health information. There is therefore the need to promote e-health in the country as a viable platform for health interventions and healthcare. This would ease the pressure and congestion that characterize physical healthcare services in the country, leading to overall improvement in healthcare delivery. 

2. Public health officials should intensify effort in promoting information literacy skills among residents of Abuja who are not well educated. They should create more awareness on available resources on health as well as teach them how to access and retrieve online health information. This would increase the use of internet for health purposes among the residents of Abuja and also reduce the risk of falling prey to misleading information online.

3. In order to minimize the risk of accessing misleading information on the internet, the Ministry of Health and other stakeholders in the health sector should take giant steps of making healthcare truly accessible to all as enshrined in international and national protocols by promoting e-health through design of responsive websites, platforms, and applications for accessing healthcare.

4. There is junk information out there, and the extent to which this might impact health outcomes must be investigated and safeguarded. In pursuit of this, there is the need for a thorough evaluation of the various websites, apps, and platforms that are health related, so that those that are not health-enhancing could be avoided.

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