• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jrsocmedLink to Publisher's site
J R Soc Med. Sep 1, 2008; 101(9): 447–453.
PMCID: PMC2587380

Health information for patients: time to look beyond patient information leaflets

‘Not having the information you need when you need it leaves you wanting. Not knowing where to look for that information leaves you powerless. In a society where information is king, none of us can afford that.’ Lois Horowitz

The 2004 United Kingdom white paper ‘Better information, better choices, better health’ sets out an ambitious strategy for the provision of health information.1 Everyone should have improved access to high quality information, health professionals should communicate more effectively with patients, and there should be a nationally coordinated process to produce and deliver information. There has been some progress towards these goals (e.g. NHS Direct now provides consumer health information by telephone, internet and digital television), but many patients and consumers still do not have access to the information they need or want, in a format they can understand.2 A lack of appropriate health information can have serious or even fatal consequences.3 As the target date for implementing the strategy is 2008, we discuss health information provision and what can be done to improve health communication.

Why do we need health literate patients?

Despite substantial investment by the NHS in quality improvement programmes, national service frameworks and the new general practitioner contract, the management of many long-term diseases remains suboptimal. One factor that limits the promotion of clinical effectiveness is low health literacy among patients (Box 1). This is a major obstacle to providing high quality care, as long-term diseases require self-management skills and the ability to negotiate complex treatments and health services.

Box 1Description of health literacy

Health literacy is the ability to obtain, understand, act on and communicate health information. A health literate individual is able to obtain and use the information needed to make everyday health decisions. Health literacy is related to, but distinct from, basic literacy (reading, writing, numeracy).4,39,40 Health literacy skills can be categorized as functional (able to read basic health information), critical (able to evaluate health information), and interactive (able to apply the information).41 All three levels are needed by an empowered patient, but functional health literacy is the foundational skill.

Low health literacy is very common. Most measures of health literacy have been developed in the USA, where approximately 40% of the population have inadequate health literacy.6 UK prevalence is unknown, but at least 20% of UK adults have literacy and numeracy skills insufficient to read simple written information; these people are at risk of having inadequate or marginal health literacy.42 Older adults, ethnic minorities, people with lower socioeconomic status, people with long-term illness or disability, and those with limited education or language proficiency are especially vulnerable to having low health literacy.4,43

As well as difficulty reading health information, people with low health literacy may be less able to comprehend verbal instructions and are less able to communicate with health professionals. Low health literacy is associated with worse global health, lack of health knowledge, increased use of emergency and inpatient services, a low uptake of preventive services, higher medical costs, and reduced compliance with treatment.44

A health literate individual has sufficient knowledge and skills to handle the information demands of the health system, communicate with health professionals, make appropriate use of health services, and contribute to optimizing the management of their own disorders.4 Patients with good health literacy skills can also act as advisers and mentors for other patients with long-term diseases and thus help spread best practice and improve disease management.

Access to information

Health literate patients require access to appropriate information to participate effectively in their health care. Health literacy is not only about access to information, but it is an important component. Engagement with health information is a prerequisite for shared decision-making and exercising choice, and limited consultation times force increasing reliance on information outside the clinical encounter.

In recent years, considerable progress has been made in increasing public access to high quality health information ( Box 2), particularly through public websites. The creation of such websites has transformed access to health information for patients who are able to use them. Patients are no longer confined to the information they receive in a patient information leaflet (‘PIL’) packaged with a medication, or leaflets picked up from their general practice or a hospital clinic. Access to information, however, is not sufficient by itself. Many people need help to find, understand and act on health information, especially written information. Even in developed countries, substantial proportions of the population have very limited literacy skills: approximately 7% of people in Sweden, 10% in the Netherlands and 20% in the UK and Ireland are classified as having the lowest level of adult literacy.5 Levels of health literacy are even lower. For example, around 40% of the US population has inadequate or marginal health literacy.6

Box 2Consumer health websites

Government sites

Medical publishers

Charities

Self-help groups

What can health professionals do?

The prevalence of low health literacy means that health professionals have an important role to play in checking patient comprehension and initiating open discussion about health information. Better information, better choices, better health recognizes this role. It says that patients should have access to information delivered in the way they want it, and that their information needs should be discussed during each contact with a health professional. They should also be supported to understand the information and be empowered to ask questions and make decisions. Taken at face value this seems to put an enormous burden on health professionals. Given that access to health information has a number of patient benefits, but does not usually have a direct effect on health,7 limited clinical time might be better spent on other matters. There are, however, simple steps that are reported to improve health communication,1,3 and these could be delegated to other members of the health care team.

The teach back method

Patients of all literacy levels benefit from plain language explanations but those who do not understand may not admit this. A simple method for health professionals to increase the amount of information communicated to patients is the ‘teach back’ technique. Patients are given information and then asked to ‘teach’ it back to the doctor. Mistakes are corrected and comprehension checked again, until the patient has correctly understood the information. The technique is frequently recommended in American literature, but seems to be less well established in other countries. Observational evidence suggests that using this method does not increase the length of consultations,8 although the method does not seem to have been tested in a randomized controlled trial.

Signposting patients to reliable information

Information provision does not have to take place within a consultation. It is often more appropriate to guide the patient to a reliable source of information and then invite the patient for a follow-up consultation if necessary. The Picker Institute has shown that a lack of signposting by UK health professionals means that patients struggle to find the reliable information they need about health services.9 Information prescriptions are one way to signpost patients to high quality, evidence-based information ( Figure 1).10–12 Pilot projects for the UK Department of Health Information Prescription scheme took place during 2007. As well as printed or alternative format resources, information prescriptions could include support or self-help groups, charities or an Expert Patient Programme. Improved communication between health services, social services and the third sector may be needed for this to happen. Further research is needed to assess the benefit of large-scale information prescription projects. The National Library of Medicine scheme has been evaluated, with clinicians and patients rating the scheme positively, but the research design was not randomized or controlled.13

Figure 1
MedlinePlus information prescription Source: United State National Network of Libraries of Medicine

Use of alternative format resources

People now access news and information in a variety of formats, including by email, from websites, on interactive digital TV, in an SMS (Short Message Service) text to their mobile, and downloaded as a podcast. The rate of technological change and uptake of new technologies is rapid. For example, data from the UK Office of National Statistics show that 55% of households had internet access in 2006, compared to 10% in 1999 (Figure 2). In many European countries the use of these technologies is even higher (Figure 2). Yet when patients visit their doctor, information provision will almost invariably follow the pattern of a verbal explanation, occasionally accompanied by a printed patient information leaflet. Alternative formats are accessible and familiar to many patients but rarely used in mainstream practice. However, there are a number of randomized controlled trials that demonstrate the use of different formats to communicate health information to patients, including audio recordings, the internet, CD-Rom, video, and text message (Box 3).14 There is evidence that these formats are in many cases more effective than traditional health communication: written information can improve health knowledge and information recall, but alternative format resources can improve health knowledge, user satisfaction, self-efficacy and health behaviour.15

Figure 2
Percentage of UK households with selected new technologies, 1998–2006 Source: Focus on the Digital Age,43 National Statistics website: www.statistics.gov.uk

Box 3Examples of different formats of health information effective at improving patient outcomes

  • Use of pictograms or pictures alongside written information,45,46 medical instrument instructions,47 and cancer screening information48
  • Information prescriptions in paediatrics10
  • Personalized information for cancer patients49
  • Multimedia programs or games for children with asthma50,51
  • Audio recordings of consultations for general practice patients and parents of infants in intensive care,52,53 and to provide information about prenatal diagnosis and asthma management.54,55 Patient-focused podcasts have not yet been tested in randomized controlled trials, but are similar to other types of audio recording
  • Use of SMS/text messaging in asthma and diabetes care56,57 and smoking cessation58,59
  • DVD/video of information about breast, prostate and colon cancer,60–62 informed consent information for intravenous contrast administration, knee arthroscopy and fracture surgery,63–65 pre-test information about HIV testing,66 pre-operative information about cataract surgery,67 and decision support for newly diagnosed hypertensive patients68
  • Websites/the internet for migraine, smoking cessation and post-operative pain management.69–72

What can health services and organizations do?

Assuring the quality of information

Figure 3
Household internet access in selected European countries, 2006 Source: Eurostat 2007: http://www.ec.europa.eu/eurostat

Most interventions to address low health literacy focus on changing the content or format of information.16 In particular, there is a substantial body of research demonstrating that internet-based health information is frequently inaccurate or incomplete.17 Concern is often expressed about consumers finding inaccurate or even harmful information.17–19 As a result, a number of quality assurance schemes have been developed, including those of the King's Fund, Health on the Net, and the International Patient Decision Aid Standards.20–22 There is little evidence, however, that clinicians or patients take account of such schemes. This focus on quality probably reflects the concerns of clinicians more than it does the concerns of patients, and does not take into account more recent sociological research.23 The structure of online information and consumer search patterns make the health information located online very similar to more traditional media sources.24 The major internet search engines such as Google use complex algorithms to rank search results. This means that websites from major organizations tend to appear first when a search is carried out. For example, searching for ‘asthma’ on Google gives a page of search results from reputable and well-known charities and organizations such as Asthma UK and NHS Direct. These sites will all provide evidence-based advice, and the risks of coming across a site that provides inaccurate or dangerous advice are small. However, although online health information is readily accessible, little emphasis has been given to improving the ability of patients to make effective use of online health information for themselves.

Improving access to information in a range of formats

Quality and access could be further supported by the development of regional or national patient resource libraries, offering patient education materials in a variety of formats. Building on the experience of ‘books on prescription’25 and online information prescription projects,10 resource banks allow information prescriptions to be provided in the format most accessible to the patient. Regional or national schemes could either be accessed directly by patients and health professionals, or as a resource to support the work of similar schemes that have already been successfully organized by patient participation groups in individual general practices.

This type of service would have financial implications for the health service, but there are also costs associated with not providing access to information. For example, Schillinger and colleagues have demonstrated that higher health literacy and physician use of interactive education are associated with better glycaemic control and lower rates of retinopathy in diabetes.8,26 Poor health literacy is associated with higher medical costs and use of expensive emergency health services.4

Addressing the information divide

As the role of information and communication technology in the delivery of healthcare increases, we need to ensure that those without access to new technologies are not unduly disadvantaged.27,28 These patients, who are more likely to be older, from ethnic minorities, non-English speaking or from lower socioeconomic groups29 should be proactively sought by practices and their needs can be met with alternative approaches.30,31 As a large program of research supported by the US government shows, the benefits of employing information technology may actually be largest for currently underserved populations.32,33 Thus a main research priority should be development of new technology solutions that empower those most in need of empowerment. However, access to technology is not the only factor to consider. Mead et al. found that an expectation that online health information will be useful is a stronger predictor of interest in using online health information than demographic factors.34 It is plausible that this attitude to internet information will become increasingly widespread as the internet and other technologies are integrated into society.

Alternative sources of health information can address the information needs of disadvantaged groups as well as extending access to information for all.35 Providing a range of information formats allows information to be tailored to the needs of the consumer, but it should not be assumed that addressing poor health literacy will inevitably reduce health inequalities.36 Particular attention needs to be paid to the information needs of consumers who do not use the internet or other new technologies, but the causal relationships between socio-economic status, health literacy and health status are far from clear.37,38

Conclusions

Both individual health professionals and health services have significant opportunities to improve health communication. Health professionals can actively guide and support patients to access and engage with high quality sources of information, as well as developing strategies to improve their own communication. These strategies are widely recommended, but conclusions about their effectiveness are currently limited by a lack of rigorous evidence. It is clear that, in many circumstances, alternative format resources are an effective and viable alternative to the printed patient information leaflet. The other strategies appear promising, but have not yet been rigorously tested and evaluated.

Footnotes

DECLARATIONS —

Competing interests None declared

Funding The Department of Primary Care and Social Medicine at Imperial College is grateful for support from the NIHR Biomedical Research Centre Scheme. AC is supported by a studentship from Imperial College

Ethical approval Not applicable

Guarantor AC

Contributorship The idea for this paper arose in discussion between AC, JC and AM. AC drafted the manuscript, with comments and collaboration from AD, JC and AM

Acknowledgements

None

References

1. Department of Health. Better information, better choices, better health: putting information at the centre of health. London: DoH; 2004.
2. Coulter A, Entwistle V, Gilbert D. Sharing decisions with patients: Is the information good enough? BMJ. 1999;318:318–22. [PMC free article] [PubMed]
3. The Joint Commission. What did the doctor say? Improving health literacy to protect patient safety. Oakbrook Terrace, Illinois: The Joint Commission; 2007.
4. Nielsen-Bohlman L, Panzer AM, Kindig DA. Health Literacy: A prescription to end confusion. Washington DC: National Academies Press; 2004.
5. Organisation for Economic Co-operation and Development, Statistics Canada. Literacy in the information age: Final report of the international adult literacy survey. Paris: OECD Publications; 2000.
6. Ad hoc committee on health literacy for the council on scientific affairs. Health literacy: report of the Council on Scientific Affairs. JAMA. 1999;281:552–7. [PubMed]
7. Coulter A, Ellins J. Patient focused interventions: A review of the evidence. London: The Health Foundation; 2006.
8. Schillinger D, Piette J, Grumbach K, et al. Closing the loop – Physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83–90. [PubMed]
9. Swain D, Ellins J, Coulter A, et al. Accessing information about health and social care services. Oxford: Picker Institute Europe; 2007.
10. D'Alessandro DM, Kreiter CD, Kinzer SL, Peterson MW. A randomized controlled trial of an information prescription for pediatric patient education on the internet. Arch Pediatr. 2004;158:857–62. [PubMed]
11. Ritterband LM, Borowitz S, Cox DJ, et al. Using the internet to provide information prescriptions. Pediatrics. 2005;116:e643–7. [PubMed]
12. Ko Y, Brown M, Frost R, Woosley RL. Development of a prescription medication information webliography for consumers. J Gen Intern Med. 2006;21:1313–6. [PMC free article] [PubMed]
13. Siegel ER, Logan RA, Harnsberger RL, et al. Information Rx: Evaluation of a new informatics tool for physicians, patients, and libraries. Inf Serv Use. 2006;26:1–10. [PubMed]
14. Suggs LS. A 10-year retrospective of research in new technologies for health communication. J Health Commun. 2006;11:61–74. [PubMed]
15. Berkman ND, DeWalt DA, Pignone MP, et al. Literacy and health outcomes. Evid Rep Technol Assess. 2004;87:1–8. [PubMed]
16. Pignone M, DeWalt DA, Sheridan S, Berkman N, Lohr KN. Interventions to improve health outcomes for patients with low literacy. A systematic review. J Gen Intern Med. 2005;20:185–92. [PMC free article] [PubMed]
17. Eysenbach G, Powell J, Kuss O, Sa ER. Empirical studies assessing the quality of health information for consumers on the World Wide Web – a systematic review. JAMA. 2002;287:2691–700. [PubMed]
18. National Institute of Clinical Studies. The impact of the internet on consumer's health behaviour. Melbourne: NICS; 2003.
19. Coulter A, Ellins J, Swain D, et al. Assessing the quality of information to support people in making decisions about their health and healthcare. Oxford: Picker Institute Europe; 2006.
20. Coulter A, Entwistle V, Gilbert D. Informing patients: an assessment of the quality of patient information material. London: King's Fund; 1998.
21. Boyer C, Selby M, Scherrer J-, Appel RD. The Health On the Net Code of Conduct for medical and health Websites. Comput Biol Med. 1998;28:603–10. [PubMed]
22. Elwyn G, O'Connor A, Stacey D, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006;333:417. [PMC free article] [PubMed]
23. Seale C. New directions for critical internet health studies: representing cancer experience on the web. Sociol Health Illn. 2005;27:515–40. [PubMed]
24. Nettleton S, Burrows R, O'Malley L. The mundane realities of the everyday lay use of the internet for health, and their consequences for media convergence. Sociol Health Illn. 2005;27:972–92. [PubMed]
25. Cuijpers P. Bibliotherapy in unipolar depression: A meta-analysis. J Behav Ther Exp Psychiatry. 1997;28:139–47. [PubMed]
26. Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288:475–82. [PubMed]
27. Hsu J, Huang J, Kinsman J, et al. Use of e-health services between 1999 and 2002: A growing digital divide. J Am Med Inform Assoc. 2005;12:164–71. [PMC free article] [PubMed]
28. Eng TR, Maxfield A, Patrick K, Deering MJ, Ratzan SC, Gustafson DH. Access to health information and support – A public highway or a private road? JAMA. 1998;280:1371–5. [PubMed]
29. Office for National Statistics. First release: Internet access, households and individuals. London: ONS; 2006.
30. Olney CA, Warner DG, Reyna G, Wood FB, Siegel ER. MedlinePlus and the challenge of low health literacy: findings from the Colonias project. J Med Libr Assoc. 2007;95:31–9. [PMC free article] [PubMed]
31. Warner DG, Olney CA, Wood FB, Hansen L, Bowden VM. High school peer tutors teach MedlinePlus: a model for Hispanic outreach. J Med Libr Assoc. 2005;93:243–52. [PMC free article] [PubMed]
32. Gustafson DH, Hawkins RP, Boberg EW, et al. CHESS: 10 years of research and development in consumer health informatics for broad populations, including the underserved. Int J Med Inform. 2002;65:169–77. [PubMed]
33. Gustafson DH, Hawkins R, Pingree S, et al. Effect of computer support on younger women with breast cancer. J Gen Intern Med. 2001;16:435–45. [PMC free article] [PubMed]
34. Mead N, Varnam R, Rogers A, Roland M. What predicts patients' interest in the Internet as a health resource in primary care in England? J Health Serv Res Policy. 2003;8:33–9. [PubMed]
35. Robinson TN, Patrick K, Eng TR, Gustafson D. An evidence-based approach to interactive health communication: A challenge to medicine in the information age. JAMA. 1998;280:1264–9. [PubMed]
36. Howard DH, Sentell T, Gazmararian JA. Impact of health literacy on socioeconomic and racial differences in health in an elderly population. J Gen Intern Med. 2006;21:857–61. [PMC free article] [PubMed]
37. Sentell TL, Halpin HA. Importance of adult literacy in understanding health disparities. J Gen Intern Med. 2006;21:862–6. [PMC free article] [PubMed]
38. Saha S. Improving literacy as a means to reducing health disparities. J Gen Intern Med. 2006;21:893–5. [PMC free article] [PubMed]
39. Kickbusch IS, Wait S, Magg D. Health Literacy: a call to action. London: The Alliance for Health and the future; 2006.
40. Zarcadoolas C, Pleasant AF, Greer D. Advancing health literacy: a framework for understanding and action. Netherlands: Jossey-Bass; 2006.
41. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15:259–67.
42. Sihota S, Lennard L. Health literacy: being able to make the most of health. London: National Consumer Council; 2004.
43. Paasche-Orlow MK, Parker RM, Gazmarian JA, Nielsen-Bohlman LT, Rudd R. The prevalence of limited health literacy. J Gen Intern Med. 2005;20:175–84. [PMC free article] [PubMed]
44. DeWalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med. 2004;19:1228–39. [PMC free article] [PubMed]
45. Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Educ Couns. 2006;61:173–90. [PubMed]
46. Mansoor LE, Dowse R. Effect of pictograms on readability of patient information materials. Ann Pharmacother. 2003;37:1003–9. [PubMed]
47. Kools M, van de Wiel MW, Ruiter RA, Kok G. Pictures and text in instructions for medical devices: effects on recall and actual performance. Patient Educ Couns. 2006;64:104–11. [PubMed]
48. Brotherstone H, Miles A, Robb KA, Atkin W, Wardle J. The impact of illustrations on public understanding of the aim of cancer screening. Patient Educ Couns. 2006;63:328–35. [PubMed]
49. Jones R, Pearson J, McGregor S, et al. Randomised trial of personalised computer based information for cancer patients. BMJ. 1999;319:1241–7. [PMC free article] [PubMed]
50. Krishna S, Balas EA, Francisco BD, Konig P. Effective and sustainable multimedia education for children with asthma: A randomized controlled trial. Child Health Care. 2006;35:75–90.
51. Krishna S, Francisco BD, Balas EA, Konig P, Graff GR, Madsen RW. Internet-enabled interactive multimedia asthma education program: a randomized trial. Pediatrics. 2003;111:503–10. [PubMed]
52. Koh TH, Budge D, Butow P, Renison B, Woodgate P. Audio recordings of consultations with doctors for parents of critically sick babies. Cochrane Database Syst Rev. 2005 CD004502. [PubMed]
53. Liddell C, Rae G, Brown TRM, Johnston D, Coates V, Mallett J. Giving patients an audiotape of their GP consultation: a randomised controlled trial. Br J Gen Pract. 2004;54:667–72. [PMC free article] [PubMed]
54. Cope CD, Lyons AC, Donovan V, Rylance M, Kilby MD. Providing letters and audiotapes to supplement a prenatal diagnostic consultation: effects on later distress and recall. Prenat Diagn. 2003;23:1060–7. [PubMed]
55. Jenkinson D, Davison J, Jones S, Hawtin P. Comparison of effects of a self management booklet and audiocassette for patients with asthma. BMJ. 1988;297:267–70. [PMC free article] [PubMed]
56. Ostojic V, Cvoriscec B, Ostojic SB, Reznikoff D, Stipic-Markovic A, Tudjman Z. Improving asthma control through telemedicine: A study of short-message service. Telemed J E Health. 2005;11:28–35. [PubMed]
57. Rami B, Popow C, Horn W, Waldhoer T, Schober E. Telemedical support to improve glycemic control in adolescents with type 1 diabetes mellitus. Eur J Pediatr. 2006;165:701–5. [PubMed]
58. Rodgers A, Corbett T, Bramley D, et al. Do u smoke after txt? Results of a randomised trial of smoking cessation using mobile phone text messaging. Tob Control. 2005;14:255–61. [PMC free article] [PubMed]
59. Vidrine DJ, Arduino RC, Lazev AB, Gritz ER. A randomized trial of a proactive cellular telephone intervention for smokers living with HIV/AIDS. AIDS. 2006;20:253–60. [PubMed]
60. Frosch DL, Kaplan RM, Felitti VJ. A randomized controlled trial comparing internet and video to facilitate patient education for men considering the prostate specific antigen test. J Gen Intern Med. 2003;18:781–7. [PMC free article] [PubMed]
61. Meade CD, Mckinney WP, Barnas GP. Educating patients with limited literacy skills – the effectiveness of printed and videotaped materials about colon-cancer. Am J Public Health. 1994;84:119–21. [PMC free article] [PubMed]
62. Walker MS, Podbilewicz-Schuller Y. Video preparation for breast cancer treatment planning: Results of a randomized clinical trial. Psychooncology. 2005;14:408–20. [PubMed]
63. Cowan EA, Calderon Y, Gennis P, Macklin R, Ortiz C, Wall SP. Spanish and English video-assisted informed consent for intravenous contrast administration in the emergency department: A randomized controlled trial. Ann Emerg Med. 2007;49:221–30. e3. [PubMed]
64. Rossi MJ, Guttmann D, MacLennan MJ, Lubowitz JH. Video informed consent improves knee arthroscopy patient comprehension. Arthroscopy. 2005;21:739–43. [PubMed]
65. Rossi M, McClellan R, Chou L, Davis K. Informed consent for ankle fracture surgery: patient comprehension of verbal and videotaped information. Foot Ankle Int. 2004;25:756–62. [PubMed]
66. Calderon Y, Haughey M, Bijur PE, et al. An educational HIV pretest counseling video program for off-hours testing in the emergency department. Ann Emerg Med. 2006;48:21–7. [PubMed]
67. Pager CK. Randomised controlled trial of preoperative information to improve satisfaction with cataract surgery. Br J Ophthalmol. 2005;89:10–3. [PMC free article] [PubMed]
68. Montgomery AA, Fahey T, Peters TJ. A factorial randomised controlled trial of decision analysis and an information video plus leaflet for newly diagnosed hypertensive patients. Br J Gen Pract. 2003;53:446–53. [PMC free article] [PubMed]
69. Sciamanna CN, Nicholson RA, Lofland JH, Manocchia M, Mui S, Hartman CW. Effects of a Website designed to improve the management of migraines. Headache. 2006;46:92–100. [PubMed]
70. Goldsmith DM, Safran C. Using the Web to reduce postoperative pain following ambulatory surgery. Proc AMIA Symp. 1999:780–4. [PMC free article] [PubMed]
71. Etter JF. Comparing the efficacy of two Internet-based, computer-tailored smoking cessation programs: a randomized trial. J Med Internet Res. 2005;7:e2. [PMC free article] [PubMed]
72. Swartz LH, Noell JW, Schroeder SW, Ary DV. A randomised control study of a fully automated internet based smoking cessation programme. Tob Control. 2006;15:7–12. [PMC free article] [PubMed]
73. Avery V, Chamberlain E, Summerfield C, Zealey L. Focus on the digital age. Basingstoke: Palgrave Macmillan; 2007.

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press
PubReader format: click here to try

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...