By Tara Coffin, MEd, CLE, PhD student

Millennials are seldom found without their mobile device. They demand instant information on any topic they might be even remotely interested in. Becoming parents does not change this quest for immediate answers to all their questions about pregnancy, labor/birth and parenting. As an educator, you may find the information you share in class immediately confirmed (or contested) by nimble fingered families with online access. You may find yourself fielding questions during or after class, that originated by a Google search from an anxious parent-to-be. Tara Coffin provides some insight into how today's families are "googling a cure" more than ever and the potential impact on you as a childbirth educator or birth professional. - Sharon Muza, Science & Sensibility Community Manager

Googling a Cure

Today, nearly 80% of Internet users in the U.S. admit to going online with their medical questions before contacting a doctor (Pew Research Center, 2013; National Cancer Institute, 2013; Fox, 2011). Social media users feel that the internet is a valuable source for health and pregnancy-related information, opting to outsource their health concerns virtually to family and friends, and through social networking sites dedicated to connecting people with shared health experiences (Huberty et al., 2013; Pew Research Center, 2013; Rodger et al. 2013; Wang et al., 2012; Lang et al., 2010; Satterlund, 2003). This trend has left many health professionals feeling uneasy about the quality and accuracy of information, wondering how these information seeking behaviors will impact the traditional physician-patient relationship (Christmann, 2013; Dizon, et al. 2012; Mostaghimi & Crotty, 2011; Greysen et al., 2010; Hawn, 2009; Wald et al., 2007; Anderson et al., 2003; Kiley, 2003; Crocco et al., 2002; Crocco et al., 2002b). Despite concerns, increasing mobile device ownership trends paired with the potential benefit to the consumer makes social media a tool that medical professionals should start to embrace.

Opportunity for Collaboration

Social media represents an expanding tool that facilitates the flow of information between peers, and between health professionals and the public. In contrast to many traditional methods of information dissemination, which focus on top-down, one-way communication, social media harbors a forum for discussion (Keller et al. 2014). Through Facebook posts and Google searches, the public is empowered to create, exchange, and consume user-generated content, transforming passive consumers into content producers (Keim & Noji 2011). Individuals post medical queries to their social media profiles and virtual communities, like Baby Gaga and What to Expect, and "armchair physicians" are quick to respond with recommendations and anecdotal evidence supporting their claim. Legitimacy is bolstered through the addition of a URL for an article, explaining just why the cure they recommended will do the trick.

Improving Access to Health Information

Recent data indicates that the trend of seeking health information through social media will continue to grow along with the increase in mobile device ownership, including smartphones and tablets (PEW Research Center, 2013; Anderson & Wolff, 2010). With the expanding availability of health information online, barriers to access start to crumble. At one point geographic isolation, transportation hurdles, work hours, or lack of childcare may have prevented an individual from accessing necessary health information (Sadler et al., 2010; Bowen et al., 2004; Doherty, 2004; Brown et al., 2000; Penchansky & Thomas, 1981). But the Internet is not bound by geographic location or business hours, enabling users to reach out for assistance, at low cost, even at 2am (Habibi et al., 2012; Macnab et al., 2012; Rojjanasrirat et al., 2012; Greene, 2011; Pate, 2009). Today, researchers focus on how social media can be used to overcome barriers that traditionally made certain populations hard-to-reach, and thus underserved and underrepresented in the arena of health information and care (Gorman et al., 2014; Seltzer et al., 2014; Yuan et al., 2014; Rabin et al., 2013).

But access to health care and health information isn't just a matter of availability and geographic accessibility; it is also about the appropriateness of what's available (Penchansky & Thomas 1981). In other words, does the care offered fit the perceived and actual needs of the intended community? In some cases, the answer is no. Take the parent who is hesitant to go into urgent care to get treatment for her mastitis. She is concerned that the care available will involve working with a doctor who is unfamiliar with the needs of a lactating parent, and might prescribe a treatment that is incompatible with breastfeeding. That internet search and social media outreach turns into a critical tool, empowering that parent to ask the right questions and become an active participant in her health care.

Benefit through Interaction

The Internet does more than improve access to health information. Fogel et al. (2002), Høybye et al. (2005), and Setoyama et al. (2011) investigated how the act of exchanging health information over an online social network benefited the individual user. While the quality of the information in these settings may be scrutinized (Meric et al., 2002; Fallis et al., 2002), users are still likely to benefit from interacting with, and sharing, health information online (Hong et al., 2012). For example, research indicates that the act of exchanging health information online may mitigate feelings of isolation, address stress associated with a health concern, and facilitate a forum to share experiences (Greene et al., 2011; Setoyama et al., 2011; Høybye et al., 2005; Eysenbach, 2003; Klemm et al., 2003; Fogel et al., 2002). And when users engage with health information in a social networking setting, they may experience a shift in attitude toward their capacity to control their own health (Freyne, et al., 2010).

Concerns about Quality of Information

While the benefit is prevalent, unfortunately so is the potential harm. Social media certainly increases access to health information through peer-to-peer exchanges, but that includes all health information, regardless of quality. A recent study explored the accuracy and quality of medical advice provided over the Internet (Chung et al. 2012). Chung et al. (2012) reported that when looking up information online about infant co-sleeping, for example, only about 43.5% of the sources assessed aligned with current American Academy of Pediatrics' recommendations, 28.1% included inaccurate information, and nearly 30% of the sources were not medically relevant. These findings align with similar studies, exploring the quality and accuracy, while comparing online health information acquisition to a game of Russian roulette (Fallis et al., 2002; Meric et al., 2002).

Call to Action

With the potential benefits and current trends in health information consumption over social media and online, it is not a matter of whether the public should participant, it is a matter of how. Birth professionals are uniquely positioned to work closely with families as they commence their late night Googling for "infant spitting up" and "cabbage leaves." Health professionals working in the birth community ought to take advantage of this opportunity, and work with clients and patients, ensuring they are equipped with the resources necessary to be informed consumers. This includes providing a list of reliable Internet resources, as well as tricks for assessing other resources they encounter. The truth of the matter is, if it is a health concern, parents are probably going to Google it before talking to their doctor. Let's make sure they have the knowledge needed to Google it well.

Tips to Share with Parents

Here are some tips for ensuring students, patients and clients are equipped to be informed consumers of online information. These are key questions to ask of any online resource, adapted from recommendations published by the NIH and the FDA:

1. Who runs the website? Quality websites make it easy to find who is behind the content. If you can't determine who is responsible for the content, then keeping browsing the web. This includes thinking about who pays for the website. Depending on who is funding the website, there may be a conflict of interest concerning the content they include.
2. What is the purpose of the website? Are they trying to sell you something? Are the authors making a claim that their product or suggestion is *the* panacea you've been looking for? Beware of websites pushing products or "wonder drugs."
3. What is the original source of the information on the website? Look to see if the website has cited where they received their information. References from peer-reviewed sources are a good sign that the information is worthwhile. Take note of how information is documented.
4. How current is the information? Reputable sites and sources are likely to be updated frequently.

What do you tell families about accessing the internet and social media for the answers to their medical questions? Have you felt that the internet sources that families rely on are similar to sites that you would refer them to as a birth professional? How do you respond when a family member or client questions information you share in class with opposing information that they found online. Please share your thoughts and experiences in our comments section. - SM.

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About Tara Coffin

Tara Coffin MEd, CLE, PhD student, is a mom, a lactation educator, and a public health researcher. She studies research dissemination in the arena of genetics and maternal and child health issues, with a focus on connecting the community with meaningful health research. With experience with educational technology, she is passionate about improving public health research dissemination and education in the virtual setting. Tara blogs about issues related to epigenetics, lactation, and public health at Milk and Genes.

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