ABSTRACT: Background: Internet access and usage is almost ubiquitous, providing newopportunities and increasing challenges for health care practitioners and users. With pregnant women reportedly turning to the Internet for information during pregnancy, a better understanding of this behavior is needed. The objective of this study was to ascertain why and how pregnant women use the Internet as a health information source, and the overall effect it had on their decision making. Kuhlthau’s (1993) information-seeking model was adapted to provide the underpinning theoretical framework for the study. Methods: The design was exploratory and descriptive. Data were collected using a valid and reliable web-based questionnaire. Over a 12-week period, 613 women from 24 countries who had confirmed that they had used the Internet for pregnancy-related information during their pregnancy completed and submitted a questionnaire. Results: Most women (97%) used search engines such as Google to identify online web pages to access a large variety of pregnancy-related information and to use the Internet for pregnancy-related social networking, support, and electronic commerce (i.e., e-commerce). Almost 94 percent of women used the Internet to supplement information already provided by health professionals and 83 percent used it to influence their pregnancy decision making. Nearly half of the respondents reported dissatisfaction with information given by health professionals (48.6%) and lack of time to ask health professionals questions (46.5%) as key factors influencing them to access the Internet. Statistically, women’s confidence levels significantly increased with respect to making decisions about their pregnancy after Internet usage (p <0.05). Conclusions: In this study, the Internet played a significant part in therespondents’ health information seeking and decision making in pregnancy. Health professionals need to be ready to support pregnant women in online data retrieval, interpretation, and application. (BIRTH 37:2 June 2010)
Bibliographical noteReference text: 1. Lagan BM, Sinclair M, Kernohan WG. Pregnant women’s use of
the Internet: A review of published and unpublished evidence.
Evid Based Midwifery 2006;4(1):17–23.
2. Lagan BM, Sinclair M, Kernohan WG. A web-based survey of
midwives’ perceptions of women using the Internet in pregnancy:
A global phenomenon. Midwifery 2009; (in press); DOI: 10.1016/
3. Romano AM. A changing landscape: Implications of pregnant
women’s Internet use for childbirth educators. J Perinat Educ
4. Kuhlthau C. Seeking Meaning. A Process Approach to Library
and Information Services. Norwood, NJ: Ablex, 1993.
5. Kalbach J. ‘‘I’m feeling lucky’’: emotions and information seeking
information. Interactions 2004;11(5):66–67.
6. Diaz JA, Griffith RA, Ng JJ, et al. Patients’ use of the Internet
for medical information. J Gen Intern Med 2002;17(3):
7. Houston TK, Allison JJ. Users of Internet health information:
Difference by health status. J Med Internet Res 2002; Accessed
September 15, 2009. Available at: http://www.jmir.org/2002/2/
8. Dickerson SS, Reinhart A, Feeley TH, et al. Patient Internet use
for health information at three urban primary care clinics. J Am
Med Inform Assoc 2004;11(6):499–504.
9. Health of the Net Foundation (HON). Analysis of 9th HON Survey
of Health and Medical Internet Users Winter 2004–2005.
Accessed September 15, 2009. Available at: http://www.hon.ch/
10. Graham ID, O’Connor A. User Manual Preparation for Decision-
Making, 1995 [updated 2005]. Accessed July 15, 2009. Available
11. Statistical Package for Social Sciences Inc. SPSS Base 14.0 for
Windows User’s Guide. Chicago: SPSS Inc, 2005.
12. Department of Health and Social Services. Delivering the Future:
Report of the High Risk Pregnancy Group, Department of Health
and Social Services, Belfast, Northern Ireland, 1996. Accessed
September 15, 2009. Available at: http://www.dhsspsni.gov.uk/
13. Selman TJ, Praskash T, Khan KS. Quality of health information
for cervical cancer treatment on the Internet. BMC Women’s
Health 2007. Accessed September 15, 2009. Available at: http://
14. Agency for Health Care Policy and Research. Assessing the Quality
of Internet Health Information, 1999. Accessed September 15,
2009. Available at: http://www.ahrq.gov/data/infoqual.htm.
15. Charnock D. The DISCERN Handbook: Quality Criteria for Consumer
Health Information. Abingdon, UK: Radcliffe Medical
16. Commission of the European Communities, Brussels. eEurope
2002: Quality criteria for health related websites. J Med Internet
Res. 2002; Accessed September 15, 2009. Available at: http://
17. Cooke P. Helping women to make their own decisions. In: Raynor
MD, Marshall JE, Sullivan A, eds. Decision-Making in Midwifery
Practice. Edinburgh, UK: Churchill Livingstone, 2005:127–142.
18. Ford S, Schofield T, Hope T. Are patients’ decision-making preferences
being met? Health Expect 2003;6(1):72–80.
19. O’Connor AM, Stacey D, Entwistle V, et al. Decision aids for
people facing health treatment or screening decisions. Cochrane
Database Syst Rev 2003, issue (2), art. no.: CD001431; DOI:
20. Stapleton H, Kirkham M, Thomas G. Qualitative study of evidence
based leaflets in maternity care. BMJ 2002;324(7338):639–
21. Mankuta D, Vinker S, Shapira S, et al. The use of a perinatal
Internet consultation forum in Israel. BJOG 2007;114(1):
22. Larsson M. A descriptive study of the use of the Internet by
women seeking pregnancy-related information. Midwifery
23. Fox S. Online Health Research, 2006. Accessed September 15,
2009. Available at: http://www.pewinternet.org/Reports/2006/
24. Hedrick J. The lived experience of pregnancy while carrying a
child with a known, nonlethal congenital abnormality. JOGNN
25. Hjelm K, Bard K, Nyberg P, Apelqvist J. Management of gestational
diabetes from the patient’s perspective—A comparison of
Swedish and Middle-Eastern born women. J Clin Nurs 2007;
26. Lalor G, Devane D, Begley CM. Unexpected diagnosis of fetal
abnormality: Women’s encounters with caregivers. Birth
27. Morahan-Martin J. How Internet users find, evaluate, and use
online health information: A cross-cultural review. Cyberpsychol
28. Shashank A, Kanitkar M, Bichile LS. Use of the Internet as a
resource of health information by patients: A clinic-based
study in the Indian population. J Postgrad Med 2005;51(2):116–
29. Al-Ubaydli M. Using search engines to find online medical information.
PLoS Med 2005;2(9):e228; DOI: 10.1371/journal.pmed.
30. Eysenbach G, Ko¨hler C. How do consumers search for and
appraise health information on the World Wide Web? Qualitative
study using focus groups, usability tests and in-depth interviews.
31. Collins English Dictionary. London: HarperCollins Publishers,
32. Handfield B, Turnbull S, Bell RJ. What do obstetricians think
about media influences on their patients? ANZJOG 2006;46(5):
33. Protti DJ. Integrated care needs integrated information management
and technology. Healthc Q 2009;13(Sp):24–29.
34. Dillman DA, Bowker D. The Web questionnaire challenge to survey
methodologists. In: Reips UD, Bosjak M, eds. Dimensions of
Internet Science. Lengerich, Germany: Pabst Science Publishers,
- decision making
- information need
- pregnant women
- web-based questionnaire