Internet accessibility and use of online health information resources by doctors in training healthcare institutions in Nigeria.

Author:Ajuwon, Grace A.


The Internet is a global network of networks that enables computers of all kinds to directly and transparently communicate throughout the world. It is described as a global network and an 'Information Super-highway' (Computer Hope 2010). It is defined as a world-wide broadcasting capability, a mechanism for information dissemination, and a medium for collaboration and interaction between individuals and their computers without regard to geographical location (The Internet Society 2010). The internet is indeed a major technological breakthrough of our time.

The Internet is a popular source of health information for health care providers and consumers. It has been recognized by many as an important mechanism for transforming medical care. The internet affords healthcare practitioners unprecedented access to huge volume, high quality, current and relevant health care information. Among currently available technologies only the Internet has the potential to deliver universal access to up-to-date health care information (Godlee, Pakenham-Wash et al. 2004). Accurate and up-to-date information is vital to maintain quality of health care. During the past decade, many health information resources have been developed and available online for use by health care professionals.

The Internet has been used by healthcare professionals to obtain and share large amounts of medical information and to monitor diseases. The knowledge of the Internet as an important health information resource for physicians have greatly improved during the past decade as a result of patterns of use and medical impact measures (Bennett, Casebeer et al. 2004). The Internet has enabled health care practitioners to obtain and share health information and to track and monitor diseases (Centre for Disease Control 2003). In addition, it has made it easy and possible for physicians throughout the world to collaborate, communicate, and interact with each other (Manhas 2008). The Internet has brought about flexible communication between patients and doctors by empowering patients with information. It has also revolutionized the compilation, assessment and distribution of information relating to healthcare (Slattery 2008).

In the last two decades, there has been a tremendous increase in the volume of healthcare information published online. The amount of online health information available to users keep growing on daily basis than can ever be imagined ten years back. A great variety of information resources are now available and accessible online. These include among others search engines (Google, Yahoo, Alta Vista, Lycos, Mama, etc) databases (MEDLINE/PubMed, Scopus, Web of Knowledge, EMBASE, African Index Medicus), portals, gateways, digital archives, libraries and institutional repositories. Recent, reliable, quality and up-to-date healthcare information are also available in websites of academic and health institutions, professional associations, governmental and non-governmental organizations. In addition, some governmental and not-for-profit organizations such as the National Institutes of Health (NIH) and Bioline International have digital archives for free full-text articles. Also available online are medical dictionaries, encyclopedias, abstracts and indexes, bibliographies, atlases, videos and drug information sources. Many of these information resources that provide accurate and reliable health care information for medical doctors are results of increase in the pace of healthcare research (Mckibbon, Fridsma et al. 2007)

Information is worthless if it is not used. Availability of information is one thing, access to and use of the available information is another (Odutola 2003). According to Dervin and Nilan, "information use" is a process whereby the user tries to make sense of discontinuous reality in a series of information use behavior (Dervin and Nilan 2003). Systems that are not utilized do not result in expected efficiency and effectiveness gains (Agarwal and Prasad 1999). Availability of e-resources has changed what users actually read and use; they tend to use what is easily accessible (Renwick 2005). The use of information varies among individuals, and professionals depending on their information needs and status. An important consideration in the process of health information gathering is accessibility and use of such information.

Literature Review

The internet has become very popular and has penetrated into many countries across the world. It is estimated that there are over 300,000 networks, 196 million domain names attached to over 5 million computers located in over 100 countries connected to the Internet (Ukwe 2010). Internet Penetration Rate (IPR) is the percentage of the population of a given country or region that uses the internet while Internet Growth Rate (IGR) is determined by comparing the latest internet usage figures for each country or region with the baseline year 2000 for internet usage figures and the ratio expressed as a percentage. According to International Telecommunication Union (ITU), an internet user is someone aged two years or older who went online in the past 30 days (Internet Worldstats 2014). An internet user is someone who has access to internet connection with the basic knowledge of internet use and has actually used the internet in the last one to two weeks. In SSA, it is not easy to determine the actual internet penetration because a subscription can be used by several people who in addition have access at work and home or in a cyber cafe.

The internet came into SSA from the early 1990s, Kenya (1993), Uganda and Nigeria (1995) and Togo in 1996 (Internet Worldstats 2014a). In 1996, only 11 African countries were connected to the internet however by the end of 2000 all 54 countries had achieved permanent connectivity (Gyapong 2002). Internet connectivity is however mainly confined to the capital cities, with very few towns being connected (Jensen 2002; Jensen 2007). Despite the fact that Africa's internet user growth rate ranks first in the world (3,606.7%); Internet penetration in the continent is the lowest (15.6%) when compared to other world regions (Internet Worldstats 2014a). Africa's poor internet status stems largely from poor telecommunication infrastructure and unreliable power supply in some countries, expense of equipment, and lack of technical skills that undermine the ability to provide cost-effective service (Royall, Schayk et al. 2005; Akpan-Obong 2007).

The number of Internet users around the world has been on the increase since the last decade. The total estimated population of the world as at June 30, 2014 was 7,182,406,565 billion while Internet users total 3,035,749,340 billion (Internet Worldstats 2014a). Noticeably, North America has a significantly higher Internet penetration rate (87.7%) than Oceania/Australia (72.9%) and Europe (70.5%). When compared to other world regions, Asia has the highest population (3,996,408,007 billion) as well as the highest population of Internet users (1,386,188,112) however; this region (Asia) has one of the lowest Internet penetration rates (34.7%). Despite the popularity of the Internet, the penetration rate is still very low worldwide, accounting for only 42.3% of the world's population. More than 20 years after the birth of the internet, two-thirds of the planets population still do not have regular internet access (UNESCO and ITU 2013).

In Nigeria, the Internet became available in 1996 and by 2000, over 150 Internet Service Providers (ISPs) had been licensed by the Nigerian Communication Commission (NCC) to operate in the country, indicating growth in access (eShekels Associates 2001). At its inception, limited e-mail services were offered by a few pioneering groups that collect emails from clients and send them in batches and also receive emails and deliver same through "snail" mail to recipients (clients). By mid-1998 there were a couple of Internet Service Providers (ISPs) operating slow links (Gelfand 2004). In year 2000, Internet penetration was (0.1%) but increased gradually to (26.5%) in 2011 (Internet Worldstats 2014b). This growth was mainly due to the proliferation of 'cyber cafes' (popular commercial access points) used by those who have no other means of access to the Internet (Ajuwon 2003; OpenNet Initiative 2009; Omolase, Balarabe et al. 2010; Omolase, Ihemedu et al. 2010).

Of the over 140 million people living in Nigeria, less than 25 million currently have access to the internet due to high access costs. There were 45,039,711 internet users in 2011 and by 2014, the number rose to...

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