Internet use in the UK continues to grow; as of 2019, 87% of adults reported using the internet nearly daily and for adults between 16 and 44 years of age this number increases to 99% (Office for National Statistics, 2019). One primary use of the internet is searching for health-related information. The use of online consumer health information has increased dramatically over the last decade, with the internet now the most popular source of human health information (Prestin, 2015; Jacobs, 2017; Bujnowska-Fedak, 2019). The percentage of people who report searching online for health information has grown from 54% in 2018 to 63% in 2019. Women look for health-related information online more often than men; 68% of women report health searches compared with 59% of men (Office for National Statistics, 2019). Reasons for this popularity include the vast amount of readily accessible health information available online and the increased engagement of people in their own health care (Amante et al, 2015; El Sherif et al, 2018). Specific topics sought by UK residents include searching for a symptom or self-diagnosing (reported by 73%), followed by how to manage a condition or illness (63%), obtain information on health improvement (39%), research potential medicines and treatments (39%), and risks associated with a procedure (38%) (Statista, 2015).
The internet as a health information resource offers several advantages including convenience, speed, accessibility, anonymity, and vast amounts of information about nearly every known medical health condition (Wald et al, 2007; Powell et al, 2011). Internet health information can help patients make informed healthcare choices, share decision-making with their healthcare provider, and make more efficient use of clinical time (Wald et al, 2007). Online health information seeking is also associated with increased patient engagement in their own health care and improved health outcomes (Renahy and Chauvin, 2006).
Yet, there are several concerns about online health information, especially since the content can range from peer-reviewed manuscripts to personal blogs that offer the opinions and anecdotes of other non-medical people. Therefore, the quality of information varies greatly. Compounding this problem, it has been suggested that many people do not possess the skills needed to critically evaluate medical information (Berland et al, 2001; Ahluwalia et al, 2010). As a consequence, online information can potentially lead patients to incorrectly self-diagnose/self-treat or request additional and unnecessary treatments or medications (Dilliway and Maudsley, 2008; Tan and Goonawardene, 2017). Internet health information can also cause strains on the doctor/patient relationship if, for example, online findings do not align with a doctor’s diagnosis. This can lead to dissatisfied patients who feel the need to change physicians or self-medicate using recommendations and medication found on the internet (Murray et al, 2003; Tan and Goonawardene, 2017).
While the majority of internet health information studies have focused on human health, some research exploring pet health information seeking behaviours have found similar results (Kogan et al, 2012; Lofgren et al, 2016). Kogan et al (2012) found a significant number of US pet owners report searching online for pet health information at least once a month (23%), with minimal differences based on gender, education level or age. Yet, despite the prevalence of this behaviour, many pet owners do not discuss their online findings with their veterinarian (22% of pet owners report never and 53.9% report only sometimes). Similar to studies assessing human health information websites, reviews of pet health websites have found the sites vary widely in accuracy and/or completeness; and that many contain inaccurate and misleading information (Jehn et al, 2003; Hofmeister et al, 2008; Taggart et al, 2010).
A recent study exploring UK pet owners’ use of the internet for pet health information found that the internet was the most frequently used information source, yet veterinarians were rated as more trustworthy (Kogan et al, 2018). Despite the common use of the internet for pet health information, less than 50% of participants reported frequently discussing information they found online with their veterinarian. Furthermore, although more than 90% of participants said they would visit veterinarian-recommended websites, half indicated that their veterinarian never made such recommendations. It has been suggested, however, that proactively directing pet owners to reputable websites for pet health information is an opportunity for veterinarians to connect with their patients and help them better understand their pets’ needs (Kogan et al, 2014; Oxley et al, 2017).
A recent study assessing UK veterinarians’ perception of their clients’ use of the internet for pet health information found that although most UK veterinarians feel their clients access the internet to find pet health information, these clients do not understand what they read online (Kogan et al, 2017). Of particular concern is the fact that 40% of these veterinarians feel that the internet has a negative impact on companion animal health. It is unknown if UK veterinary nurses share these perceptions. Given the prevalence of UK pet owners’ online searches for pet health information, the fact that the internet has become a primary health information source (Solhjoo, 2018) and the perceived risks noted by UK veterinarians, this study was designed to assess UK veterinary nurses’ perceptions and feelings associated with this behaviour.
Method
An online survey was designed and adapted from a previous survey targeting veterinarians (Kogan et al, 2017). Before distribution, the authors reviewed and pilot tested the survey, incorporating feedback into the final version. The survey consisted of 26 questions including veterinary nurse demographics, the amount of time they spend interacting with clients, perceived client internet use in general and for pet health information, how frequently they discussed online pet health information with clients and how well they felt clients understood the information they read online. Further questions included the frequency and format (e.g. written, verbal etc.) by which they suggested pet health and behaviour websites to their clients, and their perception of the overall impact of online pet health information on the veterinary team–client relationship and pet health.
Recruitment of veterinary nurses working in UK small animal/companion animal private practice/hospitals was conducted through social media platforms (i.e. Facebook and Twitter). The recruitment message on social media specifically asked for veterinary nurses who work in the UK. The survey was available April–November 2019. The study was approved by Colorado State University’s institutional review board (#19-8838H). Descriptive analyses were conducted in Microsoft Excel. Responses to the open ended question ‘Explain the reason behind your views on how clients' use of the internet for pet health information has impacted the veterinary nurse/client relationship’ were analysed using NVIVO software (version 12, QSR International Pty Ltd) to catagorise open-ended qualitative responses into categories. For each category, the number of responses and an example quotation were provided. When more than one topic was given, the first one listed was used.
Results
Demographics
A total of 152 veterinary nurses who reported currently working in a small animal/companion animal private practice/hospital completed the survey, including 136 registered veterinary nurses and 16 non-registered veterinary nurses. The time spent in their current role varied, with 19.1% reporting being in the role ‘less than a year’, 20.4% ‘at least 1 year but less than 3 years’, 22.4% ‘at least 3 but less than 5 years’, 15.1% ‘at least 5 but less than 8 years’, 5.9% ‘at least 8 years but less than 10’ and 17.1% ‘more than 10 years’. Most respondents were females living in England, 40 years of age or younger, and working full time (Table 1).
| Gender | n | % |
|---|---|---|
| Female | 146 | 96.1 |
| Male | 5 | 3.3 |
| Non-binary | 1 | 0.7 |
| Age group | ||
| 18–30 | 58 | 38.2 |
| 31–40 | 56 | 36.8 |
| 41–50 | 30 | 19.7 |
| 51–60 | 7 | 4.6 |
| =60 | 1 | 0.7 |
| Location | ||
| England | 133 | 87.5 |
| Scotland | 15 | 9.9 |
| Wales | 3 | 2.0 |
| Northern Ireland | 1 | 0.7 |
| Work full time/part-time | ||
| Full time (30 hours or more per week) | 128 | 84.2 |
| Part time (less than 30 hours) | 24 | 15.8 |
Just under half of veterinary nurses stated they spent between 25 and 50% of the average working day interacting with pet owners/clients. It was perceived by respondents that the majority (81–100%) of their clients had access to the internet either at home or work for personal use. Over 75% of veterinary nurses estimated that the majority of their clients (61–100%) use the internet to look for pet health information. Further, the majority of veterinary nurses (77%) thought that only between 0–40% of clients understood what they read about pet health online. Approximately a third of respondents reported that their clients usually discuss online pet health findings with them (Table 2).
| Percent of day spent interacting with pet owners/clients (n=152) | n | % |
|---|---|---|
| Less than 25% | 44 | 29.0 |
| 25–50% | 69 | 45.4 |
| 51–75% | 33 | 21.7 |
| Over 75% | 6 | 4.0 |
| Percent of clients thought to have access to internet (n=152) | ||
| 0–20% | 0 | 0 |
| 21–40% | 0 | 0 |
| 41–60% | 4 | 2.6 |
| 61–80% | 37 | 24.3 |
| 81–100% | 111 | 73.0 |
| Percent of clients thought to use the internet for pet health information (n=152) | ||
| 0–20% | 1 | 0.7 |
| 21–40% | 4 | 2.6 |
| 41–60% | 32 | 21.1 |
| 61–80% | 74 | 48.7 |
| 81–100% | 41 | 27.0 |
| Percentage of clients thought to discuss online pet health information (n=152) | ||
| 0–20% | 15 | 9.9 |
| 21–40% | 43 | 28.3 |
| 41–60% | 49 | 32.2 |
| 61–80% | 38 | 25.0 |
| 81–100% | 7 | 4.6 |
| Percent of clients felt to understand what they read online (n=150) | ||
| 0–20% | 51 | 34.0 |
| 21–40% | 65 | 43.3 |
| 41–60% | 27 | 18.0 |
| 61–80% | 5 | 3.3 |
| 81–100% | 2 | 1.3 |
| Percent of clients felt to trust what they read online (n=150) | ||
| 0–20% | 7 | 4.7 |
| 21–40% | 10 | 6.7 |
| 41–60% | 47 | 31.3 |
| 61–80% | 56 | 37.3 |
| 81–100% | 30 | 20.0 |
The question ‘How often do you suggest specific pet health or behaviour-related websites (NOT including your clinic’s website) to your clients?’ was answered most frequently with the response ‘less than once a month’ (43.4%, 66) (Table 2). A follow up question for those who reported suggesting specific websites asked how they provide this information to clients (n=141). The most common response was through a written copy of the website’s name and address (Table 3).
| Format of information given to clients | n | %* |
|---|---|---|
| Give them a written copy of the website name and address | 91 | 64.5 |
| Tell them the name or address of a particular website | 51 | 36.2 |
| Show them the website homepage on a computer at the veterinary clinic | 67 | 47.5 |
*Responses =100% because respondents could select more than one response
Of those who indicated they suggest specific websites (n=142), 59.2% (84) stated that clients were likely to visit the websites recommended by them, 33.8% (48) stated neither likely or unlikely, and 7% (10) stated it was unlikely.
Regarding respondents’ views on whether clients’ use of the internet for pet health information has impacted the veterinary nurse–client relationship, the majority (76.3%; 116/152) reported feeling it has had a negative impact on the client–veterinary nurse relationship (Table 4), 14.5% (22/152) stated no impact and 9.2% (14/152) stated a positive impact. Furthermore, 78.8% (119/151) felt that the internet for pet health information has had a negative impact on companion animals while only 11.9% (18/151) stated it has had a positive impact (9.3% (14/151) reported no impact). Comments regarding potential negative effects of online pet health information were categorised (Table 4). The most common negative perceived impacts included clients believing/trusting what they read online over the advice from professionals (50.5%), followed by differing or misleading, or untrained advice online (12.6%).
| Category | n | % | Example response |
|---|---|---|---|
| Clients believe/trust what they read online over the advice from professionals | 52 | 50.49 | ‘They believe the internet over a fully trained and qualified professional’ |
| Differing, misleading, untrained advice online | 13 | 12.62 | ‘Usually not an expert website or social media so a lot of misinformation’ |
| Worsens the negative/‘money grabbing’ persona | 8 | 7.77 | ‘Worsens the ‘money grabbing’ persona of this industry’ |
| Clients think they know more but haven’t assessed the quality of online information | 8 | 7.77 | ‘I feel that clients think they know more than nurses because they have read a website’ |
| They have cheaper/free/quick solutions that are not medically correct (i.e. homemade remedies) | 8 | 7.77 | ‘They find alternative ‘remedies’ such as apple cider vinegar/garlic/coconut oil and think that it'll solve their issues and that vets try and give them more expensive meds just to make money’ |
| Online misinformation makes them question our methods and treatment, doubt our skills and knowledge | 3 | 2.91 | ‘Makes them doubt our skills and feel we are not needed and often information can be used to scare clients to the point they don’t listen to us’ |
| Online information often over exaggerates minor symptoms | 3 | 2.91 | ‘Clients research minor symptoms of their animal and the internet will over exaggerate the issue. Leading the owner to think their animal is either dying or in a critical condition’ |
| Follow online advice first then bring the pet in when its health has deteriorated | 2 | 1.94 | ‘They follow online advice first and when that doesn't work bring their pet to be seen in practice. Sometimes there are complaints of cost due to the patient deteriorating, whereas if they had brought them to the vet to begin with, costs might have been reduced due to not requiring as extensive treatment’ |
| It takes a lot of effort/challenging/upsetting to convince an owner that online information is inaccurate | 2 | 1.94 | ‘Trying to dispel the myths behind vaccinations can be very challenging when your faced with a client who states vaccines kill. It is also upsetting to hear clients believe we make profit from pharmaceutical and nutritional companies, therefore making us biased and just wanting to make profit’ |
| Look online instead of visiting the veterinary practice | 2 | 1.94 | ‘Often they feel as though they no longer need to come see a nurse as they get their answers online’ |
| Causes a breakdown in communication | 1 | 0.97 | ‘Can sometimes cause a communication breakdown due to different information being presented’ |
| Costs have risen and clients feel frustrated | 1 | 0.97 | ‘Veterinary fees for consults, meds & treatment/surgery has risen significantly. Clients feel frustrated’ |
| Total | 103 |
Last, when asked how online information has impacted the amount of time veterinary nurses spend with clients, the most common response was ‘I need to spend more/much more time with clients’ (49.0%; 74/151), followed by ‘It hasn’t changed the amount of time I spend with clients’ (47.7%; 72/151), with very few indicating ‘I need to spend less time with clients’ (3.3%, 5/151).
Discussion
As most of the research relating to clients’ use of the internet for pet health information has focused on veterinarians’ and clients’ perceptions and reports, this study was designed to investigate the views of veterinary nurses. Veterinary nurses play a critical role in veterinary hospitals; they are often the ones who initiate and finalise visits, and therefore a source to whom pet owners turn for a broad range of pet information. A veterinary nurse is the liaison between the client and the veterinarian, often used to maximise veterinarians’ time by collecting client and patient information and answering clients’ questions (i.e. consultations/nurse clinics, minor surgery, general client advice, information about medication etc) (NAVTA, 2016). The tasks and communication performed by veterinary nurses are vital for the successful operation of veterinary practices.
The majority of veterinary nurses in the current study report feeling that most of their clients have access to the internet and use it to find pet health information, perceptions shared by UK veterinarians (Kogan et al, 2017). Yet, 93% of veterinary nurses feel that a significant number of pet owners do not understood what they read online; again, echoing perceptions by UK veterinarians (Kogan et al. 2017). This might help explain why 76% of respondents reported feeling that online pet health information has a negative impact on the client–veterinary nurse relationship (Kogan et al, 2017).
Further research is needed to investigate the most common sources of online information among different types of pet owners and how the quality of information varies. As previous research has highlighted, pet owners often use search engines when seeking pet health information (Kogan et al, 2018). Therefore, a review of most popular content (e.g. quality, authorship etc) for common conditions and symptoms could be investigated through online search engines. Additionally, further research pertaining to eHealth literacy differences among clients would be of value.
There are several limitations to the current study. Given the low response rate, results should be interpreted with caution and additional research involving small animal veterinary nurses of both qualitative and quanitative methods is suggested. Additionally, because the survey was conducted online and circulated through social media, it is possible that the sample was biased. This small study, however, suggests some important differences between the perceptions of veterinarians and veterinary nurses regarding the use and outcomes of pet owners accessing pet information online; namely with the increased negative perception by veterinary nurses regarding their clients’ use of the internet for pet health information. As suggested by McMullan (2006), health professionals can react defensively when presented with online health information by clients/patients or they can proactively guide them to reliable health information websites. Information prescriptions, whereby clients are directed to accurate reliable pet health information websites have been found to be positively received by clients (Solhjoo et al, 2019). Clients appreciate and utilise veterinary information prescriptions (Oxley et al, 2017; Kogan et al, 2018) suggesting that they can be a useful tool for veterinary nurses to incorporate into their client communications.
Conclusion
Given the broad role of veterinary nurses and their frequent interactions with clients, it is important to understand their views regarding pet owners’ use of the internet for pet health information. This study suggests that many veterinary nurses feel that online pet health information is not well understood by a majority of clients and can negatively impact the nurse/client relationship. Future research from the client perspective can help elucidate the impact of online searches for pet health information on the client/veterinary nurse relationship and, ultimately, pet health.