Online Health Information Seeking Behaviour of Working and

Non-working Estonian Older Adults as Compared to Students

Marianne Paimre

School of Digital Technology, Tallinn University, Narva Road 25, Tallinn, Estonia

Keywords: Online Health Information Seeking Behaviour (OHISB), Digital Divide, Older Adults, Young People,

Estonia.

Abstract: This article focuses on online health information seeking behaviour (OHISB) of Estonian older adults who

either continue or have stopped working after retirement. In order to shed light on the digital divide between

generations their OHISB was compared to that of university students’. 30 interviews with seniors and 20 with

university students were conducted followed by a think aloud protocol. The results of this study suggest that

there might not be any major differences in OHISB between working pensioners, who due to the nature of

their work have regular access to computers, and the young people. On the other hand, the working and non-

working older adults may differ markedly in this respect. The fully retired seniors not using computers or

other digital devices, cited lack of skills as the main reason for their inactivity. In order to successfully harness

all the benefits of digital solutions, the economic situation and digital skills of the senior citizens in full-time

retirement should be improved first. This article highlights the digital divide in that particular age cohort

warranting further investigation.

1 INTRODUCTION

Today, people retrieve information on health and

diseases mostly from the online environment (Dahl et

al, 2018; Fox & Rainie 2014). In the more affluent

societies, elderly people are the fastest-growing

segment of Internet users and various IT health

applications have been developed for them

(Richardson et al, 2019; Wildenbos et al, 2019;

Naszay et al, 2018). However, in poorer countries

seniors are often referred to as being deprived of the

benefits of digital society (König et al, 2018).

Statistics reveal a large digital divide between

generations especially in Eastern European countries,

and within the elderly population itself (People in the

EU, 2017).

In Estonia, heralded as the most successful digital

country in the world (Hankewitz, 2019), healthy

lifestyle apps have become increasingly popular

among younger people. It has turned out that more

than 70% of young people aged 16–24 had been

looking for health information in the last 3 months

(Statistics Estonia, 2017). At the same time, 40% of

the 65–74-year-olds do not use the Internet at all

https://orcid.org/0000-0002-7079-6513

(Statistics Estonia, 2019). Nevertheless, the ones that

need information on health and diseases the most are

seniors because of their failing health.

One of the features characteristics of Estonia, the

former Soviet republic is that its ICT sector is known

to be well advanced, yet the general standard of living

lags behind the developed countries with one of the

most conspicuous poverty rates among the older

adults in Europe. Thus, it is no wonder that the gap

between young and elderly people's use of ICT is in

Estonia larger than in the Nordic countries (European

Social Survey, 2019), because economic pressures

can be one factor preventing seniors’ access to ICT.

This article will focus on Estonia’s elderly

people’s online health information seeking behaviour

(OHISB). The primary concern for the author was

whether and how employed older adults differ from

their non-working peers in seeking health related

information. In order to shed some light on the digital

divide between generations, seniors’ OHISB is

compared to that of university students.

Health information seeking behaviour in general

means how individuals seek information about their

health, risks, illnesses, and health-protective

Paimre, M.

Online Health Information Seeking Behaviour of Working and Non-working Estonian Older Adults as Compared to Students.

DOI: 10.5220/0009424700770084

In Proceedings of the 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2020), pages 77-84

ISBN: 978-989-758-420-6

behaviours (Lambert & Loiselle, 2007; Jakobs et al,

2016; Mills & Todorova, 2016) referring also to a

series interaction diminishing uncertainty with

respect to health status (Tardy & Hale, 1998). OHISB

is usually understood as information seeking in online

environment (Risk & Petersen, 2002).

Internet usage is associated with quality of life and

well-being for the elderly people (Tennant et al,

2015). This can be also a significant tool for

supporting the senior citizens to avoid social isolation

and when solving issues associated with living

arrangements and seeking information related to

health (Rich et al, 2019). On the contrary, poor access

to ICT resource and insufficient digital skills can lead

to detachment from digital health resources, delayed

diagnoses, increased rates of hospitalization and poor

health outcomes and increased morbidity and

mortality (Berkman et al, 2011). Internet, as an

information source on health-related topics, is much

appreciated because searches can be conducted

subject to specific criteria e.g. particular symptoms or

illnesses. Print papers and magazines, although a

medium most favoured by older people, are

expensive and therefore not frequently bought or

subscribed to.

It is also paramount to study elderly people’s

OHISB to make modern healthcare systems more

effective and to develop even smarter applications in

the years to come. As the health of the older people in

Estonia tends to be poor, old-age pensions are on the

small side and the health care system overburdened,

various online health resources and IT applications

could be of considerable assistance to the senior

citizens.

The rest of the article is organized so that the

following section will provide an overview of the

previous studies on older adults’ OHISB. Thereafter

a description of the methods used in this study will be

introduced followed by the main results of the

interviews and conclusions.

2 LITERATURE REVIEW

Research on older adults’ ICT use often highlights

digital divide between generations (Din et al, 2019;

König et al, 2018; Brandtzæg et al, 2011; Xie & Bugg,

2009; Korupp, & Szydlik, 2005; Compaine, 2001).

Several studies have demonstrated that elderly people

often lack of technical and internet search skills and

are reluctant to use computers for medical purposes

(Wu and Li, 2016; Niemelä, Huotari, and Kortelainen,

2012).

Previous studies have also found that the elderly

people obtain health information from social

networks, such as healthcare providers, family

members and friends, and less from information

systems, such as the Internet, broadcasts, and

television (Pálsdóttir 2012). Research indicates that

the elderly has greater trust in those with whom they

can discuss their health actively as opposed to non-

living sources such as the Internet (Chaudhuri et al,

2013). Seniors’ most frequently search for health

information after an appointment with a doctor

(Medlock et al, 2015).

Education and familiarity with Internet searching

affect significantly task performance. Health, Internet

search experience, and information credibility

influence decisions to seek for information online.

Better education is associated with greater e-health

literacy. Females and those highly educated, report

greater use of Web 2.0 for health information

(Tennant et al, 2015).

Some researchers have examined behavioural

features of query formulation, search strategies, and

results evaluations (Huang et al, 2012). Rockmann

and Gevald found that computer self-efficacy (CSE)

and outcome expectations regarding internet-based

health information act as primary determinants of

individual’s intention to use eHealth offerings

(Rockmann and Gevald, 2015).

Erikkson-Backa and her colleagues in Finland

examined older Finnish adults’ self-perceived

capability to access, evaluate, understand and use

health related information and their perceived ability

to influence their health themselves, and the

relationship between these factors and their current

health, health behaviour and information seeking

(Erikkson-Backa et al, 2018). Results showed that

both a stronger belief in one’s capability to master

health information and to act in a healthy manner

were positively linked to better health and health

behaviour as well as more active information

behaviour.

Studies on health information needs reveal older

adults’ interest in special diseases, diagnoses,

treatments, drugs, healthcare, and health policies, but

also their changed need over time along with changes

in their health conditions (Washington et al, 2011;

Xie et al, 2010; Torp et al, 2008). There are also

indications that eHealth skills differ strongly among

the elderly people’s cohort (Medlock et al, 2015). For

example, Broekhus and her colleagues (2019)

emphasized the need for more in-depth analysis of

how age-related barriers influence the user

acceptance of eHealth. They studied how age

differences affect usability evaluations in eHealth and

ICT4AWE 2020 - 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health

found that the 55–64 age group encountered

significantly fewer usability issues compared to the

65+ age group.

According to Lam and her colleagues (2016),

existing research investigating students’ e-health

behaviour comes mainly from the medical and

nursing area (Edirippulige et al, 2008; Hercigonja-

Szekeres, Ilakovac, & Šolić, 2012; Clark, Baker, &

Baker, 2009), and thus, research on OHISB of

youngsters conducted in the fields of social sciences

and information technology is highly welcomed (e.g.

Lam et al, 2016).

It could be supposed that as young people are

usually very fond of ICT, they are also competent in

information seeking. However, some scholars refer to

their lack of competences in retrieving health

information. For example, Clark and his co-authors

(2009) found that adolescents often lack knowledge

in e-health (Clark et al, 2009).

Using a cross-sectional study design of 420

undergraduate and postgraduate students participated

in an online survey in Australia, they explored

students’ understanding of and attitude towards

eHealth, frequency of online activities and soft-ware

usage, confidence learning and using ICTs, and

perceived learning needs. They found that, although

students reported regular use of ICT, their

understanding of eHealth was uncertain or limited

(Lam et al, 2016).

Zhang (2012) explored college students' use of

social networking sites (SNS) for health and wellness

information and their perceptions of this use. He

found that using social networking sites for health and

wellness information was not a popular behaviour

among college students. Participants were also

sceptical about the quality of information, concerned

about the lack of medical knowledge of their friends

or peers and wary about possible social risks and

invasion of privacy. He concluded that SNS-s seem

not to be a well-perceived platform for health and

wellness information.

Thus, based on earlier research it is evident that

older people often face difficulties in using a

computer and, also finding relevant online health

information. However, the elderly is not a monolithic

group regarding Internet use, but some are more

familiar with ICT than the others. For young people,

on the other hand, searching for information about

health and illnesses is not a very popular activity. At

https://maaleht.delfi.ee/uudised/osale-uuringus-kuidas-

voiks-arvuti-meie-tervise-eest-rohkem-

hoolitseda?id=88247385

the same time, also they may face problems finding

the relevant information.

3 SAMPLE AND METHODS

In this study, in-depth interviews were applied to

reveal seniors’ and students’ OHISB complemented

by ‘think-aloud’ method. The latter enabled to assess

the search logic employed by the users when

answering questions proposed by the researcher.

All together 50 interviews were carried out. Thirty

interviews were conducted with seniors who either

continue (15) or have stopped working after

retirement (15) were conducted. Also, twenty

interviews with students of the University of Tartu

(13) and Tallinn University (7) were carried out.

First, five interviews with elderly people

attending various courses at a day center, but not

working any more, were conducted in May 2018.

These seniors (all 65+) of which four were females

and one male regularly participated in an arts and

crafts class and a sports club for seniors. One person

had graduated from the university, two had post-

secondary non-tertiary education, the other two had

upper secondary education. More five interviews with

seniors (65+) in full retirement in another centre were

conducted in the beginning of 2020. Three of them

had upper secondary and two higher education. Two

older people (80+) claimed to be suffering from

certain chronic illnesses. Others claimed to be in good

health.

Also, five non-working seniors were questioned

who responded to the calls to participate in the study

published in Maaleht newspaper (Rural Paper) in

December 2019.

Only six unemployed persons

responded, one (claiming not to have access to the

Internet) was excluded. All the informants were older

than 65.

In addition, all together 10 interviews with

employed older adults were conducted at the above-

mentioned universities. Five of them were members

of the administrative staff (all female) and five

belonged to the teaching staff (2 male and 3 female).

Five employed seniors were included later after the

above-mentioned call was published (all female).

Three of them worked in some hospital (1 GP, 1

specialist, and 1 secretary). The rest were officials (2).

According to the interviewees, they were in good

health considering their age (65+).

Online Health Information Seeking Behaviour of Working and Non-working Estonian Older Adults as Compared to Students

With respect to students, first, three Tallinn

University students were interviewed in autumn 2018

and four in 2019. In autumn 2019, 13 interviews were

also carried out with students at the University of

Tartu. All the interviews were recorded with a voice

recorder and processed thematically (based on the

aspects listed below) on a computer by the

MAXQDA software.

The following aspects were touched upon: 1)

whether and how often they claim to use modern

information technology for seeking information on

health and diseases; 2) what are the main reasons to

use/not to use Internet for medical purposes; 3) what

kind of information they seek for, and 4) what are the

preferred sources and how they value/trust them.

Subsequently, the OHISB of voluntary four

students and four seniors were examined in more

detail. The respondents were asked to perform three

tasks on the computer. Two of them were about

finding an answer to a question regarding specific

diseases (what is listeriosis and how to avoid it and

what is vitiligo and how to treat it). The last question

was related to establishing a diagnosis with the help

of a computer (if you experience ringing in your ears,

then what could that be and what should be done).

The participants were asked to think out loud while

solving a problem what was recorded by the

researcher. This provided more objective information

on digital skills in addition to self-reporting

Thus, as part of the initial stage, the study set out

to establish how the elderly and students themselves

comment on their OHISB, digital skills and trust in

information sources. During the second stage, the

information behaviour of the respondents was

assessed by asking them to solve a number of health-

related problems on the computer.

4 FINDINGS AND OUTCOMES

The interviews revealed different patterns in health

information seeking between the elderly persons who

continue working and those in full-time retirement.

Those who were working reported significant interest

in online information seeking and frequent

information retrieving on health and diseases.

Ten out of fifteen working older adults in this

study reported searching for health information every

week. As they often use computers anyway because

of their work, they also look up information on health

conditions as well on healthy lifestyles. The

university employees claimed to read health articles

regularly from the newspapers’ and magazines’

online editions. A lady (65) noted:

“If you sit behind the computer all day long then you

inevitably also read the news, and if you come across

a fascinating piece about medicine you just keep on

reading.”

They claimed to search actively for the medical

information by googling, but they also visit special

websites dedicated to diseases (e.g., www.inimene.ee,

kasvaja.net) or Estonian dental care portal

www.hambaarst.ee. Another lady (62) from the other

university said:

“Sometimes you might think that oh, I’m not feeling

too good and wish to learn more about a possible

condition that either you or someone close to you

might have. Then I start to Google. Or simply go

directly to some health-related web-page I know.”

Especially seniors working in hospitals claimed to

prefer certain special web-sites (medical news portal

www.mu.ww, health counselling environment

www.kliinik.ee, National Institute for Health

Development www.tai.ee etc). They pointed out their

source-criticism. On the other hand, two university

officials who did not have a higher education claimed

to use health information of varying degrees – even

an alternative online paper Telegram was considered

as a trustworthy information source. Officials and

university employees said to prefer rather online

newspapers’ health sections, e.g. tervis.postimees.ee

or health page of popular news-portal Delfi.ee

www.delfi.ee/teemalehed/tervis.

On the contrary, the interviews with seniors in

full-time retirement reported lack of access to the

Internet and smart devices, thus they have almost no

means of accessing digital health information.

Several non-working pensioners reported a

heightened interest in health issues but admitted that

they do not know how to use a computer in order to

conduct relevant online searches. For instance, a fully

retired 75-year-old lady complained:

”I am actually interested in all these health issues and

digital solutions. However, there is a big ‘but’ – I don’t

know how to use a computer. My girlfriends are the

same, none of us knows how. Nobody has taught us. I

don’t even have a smartphone. I suppose we could

even afford one as we are all drawing a pension. But

what’s the use in buying it if you do not know how to

operate it … We need proper training, special

courses!”

Another non-working lady (76) claiming to get

the relevant health information from especially from

a popular rural newspaper Maaleht, also expressed

desire to use online information, but reported lack of

skills in using ICT.

ICT4AWE 2020 - 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health

On the contrary, some seniors, especially older

ones (80+), were resolute in saying that they are not

into modern ICT at all.

ˮOh, you know, it’s a young people’s thing. I have

absolutely no interest in this. So far, I have managed

just fine without any computers and cell phones. What

can they do for me? If I need health information, I’ll

ask my doctor.”

Contrary to study conducted by Zhang (2012), which

suggests that young people are not too keen on

searching for health information online, the results of

this study reveal considerable interest in health

matters among university students. To illustrate this,

a 23-year old MA student disclosed:

ˮIt of course depends on the week. Sometimes, when I

suspect I have contracted something, then I am

constantly looking for more information on it. And

then a week goes by without any online activity on

health-related matters. If I need information, then I’ll

first turn to Estonian language sites, for example

inimene.ee, kliinik.ee. However, there are also some

sites in English that I visit relatively often.”

Female students were more inclined to look up health

information – all of them had searched for something

on health at least twice over the past week.

It would only be reasonable to assume that young

people are more interested in disease prevention

aspects (e.g. how to remain healthy, how to retain or

obtain healthy weight, which physical exercises are

most efficient, etc), yet according to them, they pay

more attention to descriptions of various symptoms

and treatment recommendations.

Forum posts were also regarded as useful sources

of information by students. Other people’s stories and

experiences were deemed valuable in making health

decisions, e.g. which doctor to see, etc. A female MA

student added:

ˮI often read posts left by others because their

experiences fascinate me. /---/. For example, I had a

tooth problem just recently, so I had mu root canal

done, but it got worse. Then I immediately checked if

and what others have posted about it in forums.”

Finding a good doctor is apparently also high on

young people’s agenda. A female student of Tallinn

University declared:

”I originally come from Rakvere (a small town in

Estonia) and I am currently looking for a family doctor

in Tallinn. I am honestly rather confused about who to

pick. Luckily, every year the biggest Estonian daily

newspaper Postimees ranks the best GP practices in

Estonia. However, the list is not complete, and you

might not even get an appointment with the top ones,

this is why I also try to see what’s being said about

different doctors in forums – who is being commended

or criticized on tervisetrend.ee.”

Two students had supplied user-generated content:

the first one had commented on a health issue in one

of the forums, the other had contributed to a Facebook

thread on vaccination in response to the publication

of a relevant article. Neither of them had initiated any

topics/discussions in online communities or

platforms. On the contrary, seniors had neither

generated nor distributed any health-related online

content on their own.

Young people noted that they only read content

that originates from a reliable online source.

According to them, the list of websites offering

reliable health information includes hospitals

(kliinikum.ee), public research institutes, e.g. the

National Institute for Health Development (tai.ee)

and specialists (derma.ee) that show up on the first

page of Google. They were convinced that the search

results displayed by Google first were actually worth

reading. Yet, they admitted that some material which

might seem interesting enough to read (e.g. forums

and alternative media sources) and maybe even

ranked high on Google should be taken with a grain

of salt. However, in case of conflicting opinions – the

official source says one thing, but it is second-guessed

in forums – then the authors of forum posts tend to

prevail in this dispute. A 30-year-old historian, is a

good case in point:

”For instance, if I have a medical problem then I always

consult with forums first to see what other people are saying

about it. If discrepancies exist between the information

published by some official site and forum, then I believe the

latter, i.e., forum post.”

Conversely, the elderly place their trust in official

sites as opposed to forums. They preferred official

sources and newspaper online versions next to

Wikipedia.

While the employed seniors themselves did not

think too highly of their digital skills (only 4 in 15

were content with their IT skills), then the results of

the actual tasks given to them revealed that seniors

did not perform less well than the young. Moreover,

seniors who often used computers were able to find

the correct diagnosis corresponding to the original

description provided by the researcher faster and

more efficiently. This could be explained by the fact

that in the course of their longer lives they have had

to look up various conditions on the Internet, i.e., they

have had more practice. But it could also result from

the fact that seniors working at the university, in the

Online Health Information Seeking Behaviour of Working and Non-working Estonian Older Adults as Compared to Students

hospital or public services are simply better

information seekers than students as they use more

accurate search words or more relevant sources for

their queries as well as resort to more efficient search

strategies (e.g. when googling for the answer they

were quick to find the website of the Health Board or

some health information site where Estonian

language articles are presented in a concise manner

together with the necessary explanations).

To illustrate this further, when trying to learn

about listeriosis and how to avoid it, some students

immediately started searching for this information in

foreign language scientific articles or student papers

stored in digital libraries to retrieve some useful

references, yet it would have been much faster to get

the correct answer by visiting the websites of the

Health Board or Tartu University Hospital.

In summary, both the elderly and young people

were very interested in the health issues. It was

somewhat surprising that students often claimed to be

searching for diseases. Elderly people with higher

education and still working seemed to be the most

source critical. Unlike the elderly, young people often

sought health information in forums and sometimes

share health related content on social network sites.

Several senior citizens claimed not to use computers

were actually very interested to search health

information online. They complained about lack of

skills.

It is important to keep in mind that the elderly

have very different online behaviours and digital

competencies when developing health applications.

5 CONCLUSIONS

The study revealed great differences in OHISB

between working older adults and those in full

retirement. If a person uses a computer at work every

day, then he/she is also more inclined to look up and

obtain health information online. Two thirds of

employed seniors claimed to search for health-related

information every week. They both passively

consume medical news from the newspapers and

health magazines online editions and actively search

special medical information websites. Often concern

about one’s health is a driving force for information

seeking. Employed older adults also highly valued

their information-seeking skills.

On the contrary, interviewees not working any

more replied that they made very little use of the

Internet. They did not regard online information as

reliable and claimed to get almost all the essential

health and disease-related information from the so-

called live sources, e.g. mostly from their medical

doctors or newspapers’ health pages. However,

several non-working pensioners claimed that they

would like to use IT and would even have the

necessary means to purchase a computer or some

similar device, but nobody had taught them how to

use such gadgets. Others, especially the oldest

respondents, also referred to lack of interest.

Young people’s interest in disease and health

information proved to be much greater than originally

anticipated. The elderly employees could be

distinguished from students mainly in respect of not

actively generating and sharing health content on the

Internet. In contrast to the results of some studies

conducted abroad (e.g. Zhang 2012), it can be said

that for Estonian youth online has become a kind of

leisure activity.

When developing digital applications, the

disparities in readiness to use ICT among the older

demographic in Estonia should not be overlooked.

However, some of them cope equally well with the

young and are actively seeking health information

from online sources. Others lack any experience with

computers and smartphones although they would like

to use them. The third group is simply not interested

in digital technologies.

As many non-users in Estonia also belong to the

55–65 age bracket, training programmes designed for

people 55+ should be launched as a matter of

urgency.

As the sample was too small, the study did not

allow to analyse the impact of various background

factors (e.g., family status, occupation, education) on

OHISB. One of the shortcomings of the study lies in

the fact that the sample failed to include any seniors

working in positions where performance of their

duties does not involve regular use of computers.

This qualitative research serves as an introduction

to a more comprehensive survey which will collect

data regarding OHISB and online health literacy

among Estonian older adults (55+) as well as their

aptitude for various applications. This allows for an

identification of distinct older adults' profiles in their

OHISB and a better grasp of their needs/difficulties

in using e-health.

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ICT4AWE 2020 - 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health