Final Literature Review

LITERATURE REVIEW ON WOMEN’S ACCESS TO HEALTH
INFORMATION
LITERATURE REVIEW ON WOMEN’S ACCESS TO HEALTH INFORMATION...................1
TRENDS AND PREFERENCES IN ACCESSING SOURCES OF HEALTH INFORMATION . 5
As discussed, there are numerous sources of health material differing greatly in quality, type and
currency. However, improvements in women’s own and their family’s health will not happen
unless certain barriers to using health information sources are overcome. The first of these is that
of health literacy; it is important to ensure that women know how to source appropriate, quality
information, comprehend it, and apply it to their lives. The second is to overcome barriers
created by the information itself, such as it being incomplete or unspecific and not quality
assured. Finally, there are barriers to using these sources of health information related to
women’s time constraints and women’s specific circumstances........................................................18
Incarcerated women and specific health needs...................................................................................24

Improved decision making and communication ................................................................................40
IMPROVING NATIONAL HEALTH LITERACY..............................................48
THE ROLE OF WOMEN’S HEALTH CENTRES............................................50
CONCLUDING COMMENTS..........................................................................52
EXECUTIVE SUMMARY.................................................................................52
CONCLUSION.................................................................................................53
1
Introduction and Background for Literature review
The Women’s Centre for Health Matters (WHCM) is a community-based

organisation that aims to provide women with access to reliable and broad
ranging health-related information, to be an advocate for the improvement of
health-related services, and to empower women to have optimal health and
wellbeing. This literature review is intended to supplement a survey of
women’s access to health information, their needs and trends, undertaken by
WHCM in 2009, and to provide a basis for further research.
Rationale
There are a number of reasons it is important to understand how women

access health information from a variety of sources, the current trends, and
women’s preferences. Firstly, women clearly want guidance and more
information on health matters, but they often encounter barriers in obtaining
current, relevant and credible health information. Personally relevant health
information not only enables women to make informed decisions about
medical procedures but also optimises their general health and wellbeing.
Secondly, it is vital for women to be able to access quality health information

as they are the primary seekers of health information as well as the main
decision makers with regard to their own and their family’s health. Access to
quality health information enables women to make use of health and
wellbeing services when necessary and, for minor matters, to use that
information as a substitute for consultations with health professionals.
Thirdly, access to health information increases the likelihood that women and
their families will undertake positive lifestyle changes to improve their health
and reduce their risks and subsequent burden of preventable illness and
stress.
Fourthly, understanding the sources of health information used, and preferred

by women, is invaluable in the continued improvement of services providing
such information. These services need to ensure the information is accurate,
can be disseminated and, easily applied by women.
The way in which women access health information, and their confidence in
doing so, changes over their lifetime and in response to technology and
different styles of health information and services available. Health information
providers must also be aware of issues especially concerning women, such
as reproductive health, breast cancer and domestic violence. Such issues
require sensitive attention as available information can be distressing,
factorial, opinionated and often overwhelming. There is also a need to provide
additional services to help groups of women with specific needs, for example
those who come from Culturally And Linguistically Diverse (CALD)
backgrounds, women who are illiterate, and those with disabilities to ensure
they have effective access to the health information they need.
2
Objectives
The primary aim of this literature review is to accompany the Women’s Centre
for Health Matters (2009) Survey on Women’s Access to Health Information in
the ACT. Other objectives of the literature review include:
• To provide evidence based literature to help analyse and discuss the

WCHM ACT Women’s Access to Health Information (2009) Survey
findings. Find similarities and differences and compare study findings
to be able to comment on national and international trends.
• To build upon previous research by Women’s Health Victoria (2003)
which revealed a deficiency in access to health information for
Australian women, and to determine whether that deficiency continues
to exists for women in the ACT.
• To respond to women who have voiced dissatisfaction with their
access to health information and validate the need to improve women’s
access to health information. Adequate access to quality health
information (i.e. good health literacy) is seen by the WCHM as an
essential part of empowering women and promoting ACT women’s
health and wellbeing.
• To examine the growing body of academic research on how adults,
particularly women, access and use health information, giving special
attention to sources used and boundaries faced by specific groups of
women.
• To analyse the impact of technology on the means and trends of
accessing health information, such as what sort of health information
women are seeking i.e. is it to diagnose acute medical conditions, find
specialists, for general health information, or to network with others
who share their health conditions.
• To define key terms for analysis and future research in this field of
study.
Boundaries of the review
Several boundaries governed the scope of this literature review. Firstly, all
articles are from peer reviewed journals to ensure high standards of research.
Secondly, almost all literature was published since 2002. This was to avoid
duplicating analysis of literature already discussed in papers from the Key
Centre for Women’s Health in Society (covering 1986-1998) and the Women’s
Health Victoria (covering 1998-2003).1, 2 However, some articles prior to 2003
have been mentioned if they have remained relevant to issues and trends
discussed. Another reason for predominantly using recent articles is to take
into account the rapid increase in Internet usage in recent years. Studies
1
Murphy, M. & Murphy, B. (2003). “Access to Women’s Health information: A
survey of Victorian women as Information Seekers”, Women’s Health Victoria,
Melbourne, 3.
2
Astbury, J, and D. White. (1998) “Addressing women’s health information
needs: the adequacy of current and emerging health information systems. A
literature review”. Melbourne: Key Centre for Women’s Health in Society.
3
chosen were not confined to only those with women as their participants/focus
of study, however, to be included in the review studies had to mention
women’s access to health information or a trend or barrier specific to women.
The review focused on local and national research but international studies
have also been assessed for analysis.
Methodology for Literature Review
This literature review was undertaken by searching for relevant peer reviewed
articles in the academic databases Medline/Pubmed,3 CINAL4 and OVID.5 All
searches were restricted to 2000 onward and written in English. A few
additional searchers were done by following the references of important
articles if those articles met the defining criteria (of English language, post
2000 and peer reviewed).
Major search terms used were ‘women’ with ‘access to health information’,
‘health seeking information’ and ‘health literacy’. Thousands of articles were
found. After a cursory review, 59* articles were selected for closer study on
the basis of their relevance to the review’s objectives. Reports from the
Australian Bureau of Statistics were also used to find prevalence rates and
statistics for specific questions such as Internet usage.
3
http://www.ncbi.nlm.nih.gov/pubmed/
4
http://www.ebscohost.com/cinahl/
5
http://www.ovid.com/site/index.jsp
4
DETAILED REVIEW OF FINDINGS
TRENDS AND PREFERENCES IN ACCESSING SOURCES OF HEALTH

INFORMATION
Australian women access health information using a variety of sources and for
a multitude of health and wellbeing reasons during their lifespan.6,7
Women access health information both through actively seeking out the
information to meet specific needs and through the passive absorption of
health information available. Active access to health information includes
looking up resource materials (e.g. Internet websites or books) or making
consultations with health care professionals. Passive forms of health
information occur through exposure to the media, as well as everyday
discussions and interactions.8 Research indicates that while some individuals
actively seek out health care and information, others will live with pain, stress
and ill health for a long time without seeking adequate health information or
medical services.9 Research shows, not seeking out specific information to
meet one’s needs, only passively absorbing health information, or being a
passive patient (i.e. less involved or interested in one’s health decisions)
results in less positive health and lifestyle choices that can drastically affect
women’s (current and future) health and wellbeing.10,11
Recent years have seen a huge socio-political shift towards individuals being,
or desiring to be, more active and informed about their health and lifestyle
choices. Smith et al. confirms that increasingly individuals feel pressured to be
better informed about, and take more responsibility for, their health.12 This
global trend to be more informed and active participants in one’s health and
6
Murphy, M. & Murphy, B. (2003). “Access to Women’s Health information:
A literature review of women as health information seekers”, Women’s Health
Victoria, Melbourne,5-7, 33-6.
7
Wyn, R. & Solis, B. (2001). “Women’s health issues across the lifespan.
Women’s Health Issues”,11(3),148-159.
8
Murphy, M. & Murphy, B. (2003) “Access to women’s Health information: A
Melbourne, 16.
9
Mortimer, M. Ahlberg, G. & MUSIC-Norrtalje Study Group (2003). ”To seek
or not to seek? Care-seeking behaviour among people with lower back pain”.
Scandinavian Journal of Public Health, 31,194-203.
10
Brown, R., Butow, P., Henman, M., Dunn, D., Boyle, F &Tattersall, M.
(2002). “Responding to the active and passive patient: flexibility is the key”.
Health expectations, 5, 236-245.
11
Murphy, M (2003) “Access to women’s health information: Research
Summary”, Women’s Health Victoria, Melbourne, 7.
12
Smith, S., Dixon, A., Trevena, L., Nutbeam, D. & McCaffery, K. (2009).
“Exploring patient involvement in healthcare decision making across different
education and functional health literacy groups”. Social science & Medicine,
69, 1805-1812.
5
lifestyle choices is especially true for women.13,14 For women to be
autonomous, responsible and make positive informed health decisions, it is
essential that they have easy access to quality health information. The term
“health literacy” is defined as being able to obtain, sort and comprehend
health information to meet one’s needs. Thus the optimal health and wellbeing
of women relies on access to good quality, trustworthy, appropriate and easily
accessible health information.15
The changing nature of the general public being more responsible and
informed on health matters is changing the General Practitioner (GP) / patient
relationship with differing roles, expectations, responsibilities and demands for
both parties.16
General Practitioners
A major finding of the Women’s Health Victoria Survey of Women’s Access to

Health Information (2003) found that General Practitioners (GPs) are
considered the primary source, as well as the preferred source, of health
information for women. Of the women surveyed 95.8% had previously sort
health information from their GPs.17 Women of all age groups reported GPs as
their preferred channel of health information, though the strength of this trend
correlated with increasing age.18 As well as GPs being a frequented and
preferred channel, research indicates that women consider GPs to be the
most trusted source of health information.19 General Practitioners consider the
provision and education of health information to their patients as an important,
13
Kummervold, p., Chronaki, C., Lausen, B., Prokosch, H., Rasmussen, J.,
Santana, S., Staniszewski, A. & Wangberg, S. (2008) “eHealth trends in
Europe 2005-2007:a population-based survey”, Journal of Medical Internet
Research, 10(4), e42.
14
Rahmqvist, m. & Bara, A. (2007). “Patients retrieving additional information
via the internet: a trend analysis in a Swedish population, 2000-2005”.
Scandinavian Journal of Public Health, 35(5), 533-539.
15
education and functional health literacy groups”. Social Science & Medicine,
69, 1805-1812
16
69, 1805-1812.
17
A survey of Victorian women as Information Seekers”, Women’s Health
Victoria, Melbourne 12.
18
Murphy, M & Murphy, B. (2003) “Access to women’s Health information: A
Melbourne,15.
19
Pennbridge J, Moya R, Rodrigues L.(1999). “Questionnaire survey of
California consumers’ use and rating sources of health care information
including the Internet”. Western Journal of Medicine.171(5-6), 302-305.
6
if not essential, part of their professional role.20, 21
The trend of women’s preference for the GP to provide individuals with

relevant health information is international with significant evidence from
studies such as Cowan & Hoskins from the United Kingdom. However,
despite the trend for GPs providing the majority of health information, the
studies also found that most women do not feel the information provided is
enough and still actively have to seek health information from additional
sources. 22
It is unsurprising then that despite the preference for GPs to provide

trustworthy information, many of the studies analysed suggest that women are
not fully satisfied with GPs’ information provision and want more and better
quality information for a variety of topics, especially on sexual health.23
Warner & Procaccino’s research reported two reasons why women are not
satisfied with GP information provision. Firstly, women felt rushed during their
GP consultation, leading to them feeling unable to ask additional questions.
Secondly, women felt the information provided was not clear or thorough
enough to satisfy their health literacy needs and to develop their
understanding.24
Additional research confirms this trend. Ziegler et al. found that over 76% of
adults specifically wanted their GP to provide more information concerning
adverse effects of medications.25 Wyn & Solis’s specific research on
‘women’s health issues across the lifespan’ found that health information
about general lifestyle choices and healthy behaviors was rarely discussed
with women during their GP visits. Such a finding was particularly
disheartening considering the women from the study suffered from chronic
preventable illness but were actively engaging in detrimental or risky
behaviors (such as smoking, overeating and lack of exercise) making them
20
Waters, E., Haby, M., Wake, M. & Salmon, L. (2000). “Public health and
preventive healthcare in children: current practices of Victorian GPs and
barriers to participation”. Medical Journal of Australia, 173(2), 68-71.(only got
abstract)
21
Murphy, M., Murphy B. & Kanost, D. (2003). “Access to Women’s Health
Information: A Literature Review of Health Professionals as Information
Providers”, Women’s Health Victoria, Melbourne, 14.
22
Cowan, C. & Hoskins, R. (2007). “Information preferences of women
receiving chemotherapy for breast cancer”, European Journal of Cancer
Care, 16(6), 543-550.
23
Melbourne, 24.
24
Warner, D. & Procaccino, J.D. (2004). “Toward Wellness: Women Seeking
Health Information”, Journal of the American Society for Information Science
and Technology, 55(8), 709-730.
25
Ziegler D., Mosier, M., Buenaver, M. & Okuyemi, K. (2001). “How much
information about adverse effects of medication do patients want from
physicians?”, Archive of Internal Medicine, 161, 706-713.
7
more susceptible to degrading health.26
Despite the high demand and preference for GPs providing women with
adequate health information, there are significant barriers impacting on this
process. Women’s Health Victoria’s A Literature Review of Health
Professionals as Information Providers found several barriers discouraging
health care providers from providing adequate health information to their
patients. These included insufficient time with patients by having truncated
consultations and the lack of remuneration for providing preventative health
care/information.27 This is reiterated by Waters et al. whose survey of 804
Australian GPs reveals that GPs felt the four key barriers to providing
adequate health information were: 1) time constraints, 2) lack of remuneration
for doing so, 3) the inappropriateness of providing preventative care when
patients are facing acute illness, and 4) lack of community resources.28 Such
barriers are systemic. On an individual GP level, Girgis & Sanson-Fisher
reported from a survey of Australian interns that although 64% felt competent
in technical skills, only 35% of interns felt competent in patient interactions,
which includes the provision of quality health information such as optimal
behaviour changes and prognosis.29
Thus, for many women the preferred source of health information, their GP, is
insufficient to meet their health care needs and they must access health
information from other sources. Australian women have reported they see the
barriers to GPs being sufficient sources of health information as lack of time
with them, the depth and breadth of information provided, and a lack of
knowledge on specific information such as on sexual health issues. 30, 31 In
addition, the Women’s Health Victoria Survey found practitioner concerns
over the changing GP/patient relationship, (with women being more informed
(or misinformed) and autonomous), was also noted as a barrier by which
practitioners might restrict or inhibit women’s knowledge or ability to be given
more information on a topic.32
26
Wyn, R. & Solis, B. (2001). “Women’s health issues across the lifespan”.
Women’s Health Issues, 11(3),148-159.
27
Providers”, Women’s Health Victoria, Melbourne, 6-7.
28
Waters E., Haby, M., Wake, M. & Salmon, L. (2000). “Public health and
barriers to participation”. Medical Journal of Australia, 173(2), 68-71. (only got
abstract)
29
Girgis A, & Sanson-Fisher R. (1998). Breaking bad news 1: Current best
advice for clinicians, Behavioural Medicine, 24(2) (CANT SEEM TO FIND- in
Murphy tho)
30
Murphy, M & Murphy, B. (2003). “Access to women’s Health information: A
Melbourne, 24.
31
32
Murphy, M., Murphy, B. & Kanost, D.(2003) “Access to Women’s Health
8
The Women’s Health Victoria Survey lead the way for Australian studies on
health information finding that many Australian women using their GP as their
primary source of health information report they would use GP’s less if they
felt they could find quality, reliable health information elsewhere33. This raises
the possibility that the burden on GPs could be reduced if women felt more
comfortable accessing, and had more faith in, information from sources other
than their GP.34
The Internet
Consistent research indicates that Internet usage is dramatically increasing

across Australia and the globe.35 It has infiltrated many work and living spaces
and impacted society and communication in a similar way the telephone did in
the late nineteenth, early twentieth century.36 The Internet is also increasingly
being used as a source of health information, with young women consistently
being the most active in this regard.37, 38 Many studies suggest that individuals
are using the Internet to find health information both passively and actively
and to answer specific health queries.39, 40 Indeed Kummervold’s et al.
significant study (N=14 956) from seven European countries found that 46.8%
of their sample perceive the Internet as an “important” source of health
Providers”, Women’s Health Victoria, Melbourne, 6, 27.
33
Victoria, Melbourne, 24.
34
35
Europe 2005-2007: a population-based survey”, Journal of Medical Internet
Resources, 10(4), e42.
36
Pandey, S., Hart, J., Tiwary, S. (2003). “Women’s Health and the internet:
understanding emerging trends and implications”. Social Science & Medicine.
56(1), 179-191.
37
Santana, S., Staniszewski, A. & Wangberg, S. (2008). “eHealth trends in
Europe 2005-2007: a population-based survey”, Journal of Medical Internet
38
Scandinavian Journal of Public Health, 35(5), p533-539
39
Santana, S., Staniszewski, A. & Wangberg, S. (2008) eHealth trends in
Europe 2005-2007:a population-based survey, Journal of Medical Internet
40
via the internet: a trend analysis in a Swedish population”, 2000-2005.
Scandinavian Journal of Public Health, 35(5), p533-539
9
information, a significant increase from previous years, while the importance
of other sources of health information stayed level or decreased.41
Consistent academic evidence suggests that although the Internet trend is

increasing across all generations, young women remain the most active users
of the Internet to find health information.42, 43, 44 The Australian Women’s
Health Victoria Survey found that despite the recognised often-poor quality of
information found on the Internet, it was the second most preferred source of
health information.45 At that time the Australian Bureau of Statistics (ABS)
found only 37% of Australian households had access to the Internet.46 Current
ABS statistics of Internet access at home have shown massive increases in
Internet connections over the past decade, with 72% Australian households
having Internet access in 2008.47 Of those 28% of Australians without the
Internet at home, 47% had no interest or use for the Internet and another 25%
had accessed the Internet though other sites such as work, tertiary institutions
or family and friends’ houses.48 For Australian women, Internet usage is
associated with being middle age or younger, having a partner and/or
(dependent) children, having completed tertiary education, having Internet
access and having a good income.49 Pertinent to this literature review and
accompanying WCHM survey is the fact that the ACT has the highest
41
42
43
via the internet: a trend analysis in a Swedish population”, 2000-2005.
Scandinavian Journal of Public Health, 35(5), p533-539.
44
Atkinson, N. Saperstein, S., & Pleis, J. (2009) “Using the internet for health-
related activities: findings from a national probability sample”. Journal of
medical Internet Research, 11(1), e4.
45
Victoria, Melbourne, 15, 25.
46
Australian Bureau of Statistics (2000). “Use of the Internet by
Householders. Australian Bureau of Statistics, (Catalogue No. 8147.0),
Canberra. Found at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/8147.0/
47
Australian Bureau of Statistics (2008-9). “Household use of information
technology, (Catalogue No 8146.0), Australia 2008-9”, Canberra. Found at:
http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/8146.0
48
Australian Bureau of Statistics (2008). “Australian Social Trends: Internet
access at home (Catalogue No 4102.0), Australia 2008-9”, Canberra. Found
at:http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Chapter10002
008
49
Victoria, Melbourne, 14-15.
10
proportion of households in Australia with a broadband Internet connection
(74%).50 This means that a huge number of Australian, and particularly ACT,
women have convenient access to the Internet as a potential source of health
information.
Alkinson et al. believed that the Internet was the most widely used health
information channel with a conservative 2003 estimate of 12.5 million health
information searches a day and this number is rising rapidly.51 The type of
health information which women access on the internet tends to correlate with
women’s educational and economic status, with numerous studies finding that
better educated women are more likely to seek factual information on the
internet to supplement other sources,52 while less educated women use the
internet more to access online support groups.53
Although young women use the Internet readily there is an increasing

acceptance of older generations of women using it for information and to
communicate and connect with others.54 This is confirmed by Wilson et al.’s
2008 study finding that older Australians are increasingly accepting and using
the Internet as a source of health information. However, although this
acceptance is rising there remain disparities in the ease of access to health
information via the Internet for older Australians (and globally) between those
who are more socially connected and of higher socio-economic brackets, and
those less socially connected, less educated and well off. 55, 56
An extensive Swedish study of 24 800 adults indicates that women are using
the Internet significantly more than men to find additional health information
after seeing health care providers, and its use increases with decreasing
50
Australian Bureau of Statistics (2008-9). “Household use of information
technology (Catalogue No 8146.0), Australia 2008-9”, Canberra. Found at:
http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/8146.0
51
Atkinson, N. Saperstein, S., & Pleis, J. (2009). “Using the internet for health-
related activies: findings from a national probability sample”. Journal of
52
Pandey, S., Hart, J., Tiwary, S.(2003). Women’s Health and the internet:
understanding emerging trends and implications. Social Science & Medicine.
56(1), 179-191.
53
Atkinson, N. Saperstein, S., & Pleis, J. (2009) “Using the internet for health-
54
Kummervold, P., Chronaki, C., Lausen, B., Prokosche, H., Rasmussen, J.,
Santana, S., Staniszewski, A. & Wanberg, S. (2008). “eHealth trends in
Europe 2005-2007: a population-based survey”. Journal of Medical Internet
Resources,10(4),42.
55
Wilson, C., Flight, I., Heart, E., Turnbull, D., Cole, S. & Young, G. (2008).
“Internet delivery of health information to South Australians older than 50”.
Australian and New Zealand Journal of Public Health, 32(2), 174-176.
56
11
health (no doubt trying to fill greater medical need).57 A recent study by Dey et
al. of women attending a breast screening service in NSW found that 62% of
their clients had used the Internet specifically to find health information. The
surprising statistic though was that 70% of the women expressed that they
would use the Internet if they were diagnosed with breast cancer, a potentially
life threatening health condition.58 If women are using the Internet to find
information about a serious health conditions, it must be acknowledged that
this source has the potential to both help and harm.
This use of the Internet for serious or chronic health conditions is particularly
pertinent given Kontos et al.’s reported “decreasing digital divide” allowing
many individuals of low socio-economic and educational level to access the
internet for health information, without experience or knowledge of how to do
so effectively. Such individuals tend to have risk factors contributing to poorer
health and reportedly often lack the technical skills and experience of how to
access reputable websites or how to check if the information is current and
credible. 59, 60 Individuals being led astray with poor quality information could
already be occurring, as suggested by a paper from The Journal of the
American Society for Information Science and Technology finding that
predominantly women access health information only through common search
engines and were unaware that many websites’ primary aim was to push a
particular political, religious, or economic agenda in selling merchandise or a
service. Indeed none of the women surveyed actively searched for who was
behind the site or what evidence backed the claims made.61
Evidence indicates patients’ interactions with their health care providers and
their involvement in healthy lifestyle choices and health care decisions are
strongly influenced by the Internet.62 As well as influencing decisions and
communication, Sillence, et al. reported that women often use the internet to
find personalised stories from those with a similar health issues to validate
their feelings, connect with others and improve trust in physicians as clinical
57
58
Dey, A., Reid, B., Godding, R., & Campbell, A., (2008). “Perceptions and
behaviour of access of the internet: a study of women attending a breast
screening service in Sydney, Australia”, International Journal of Medical
Informatics, 77, 24-32.
59
Kontos, E., Bennett, G., & Viswanath, K. (2007). “Barriers and facilitators to
home computer and internet use among urban novice computer users of low
socioeconomic position”, Journal of Medical Internet Resources, 9(4), 31.
60
Warner, D. & Procaccino, J.D. (2007). “Towards Wellness: Women seeking
health information: distinguishing the web user”. Journal of the American
Society for information science and Technology, 55(8), 708-730.
61
Warner, D. & Procaccino, J. (2007). “Towards Wellness: Women seeking
62
Sillence, E., Briggs, P., Harris, P., & Fishwick, L. (2007). “How do patients
evaluate and make use of online health information?”, Social Science &
Medicine, 64 (9), 1853-1862.
12
information can be discussed in a more personalised manner.63 There is a
trend for women with higher educational levels to seek out more factual health
information, while online support groups and social networking are particularly
sought by women with poorer health and less income and educational level.64
Indeed research from the United States indicates highlights that women are
increasingly seeking online support networks to help fulfil their “need to be
heard and respected when they looked for information about their health or on
behalf of others,” which they may not receive from other health information
sources.65 This could partially be put down to conclusive evidence that many
studies show that woman are unable to find adequate time to discuss health
information or their concerns during their rushed visits to their GPs.66, 67
Telephone Help Lines
In Australia, telephone help lines are a minor source of health information

compared to other sources, with the Women’s Health Victoria (2003) Survey
finding only 7% of women surveyed use one as a source of health
information.68 Telephone lines such as QUITline however still receive over
130 000 calls a year, for counselling to help improve health and reduce
tobacco consumption and provide health and wellbeing information.69 A New
Zealand study found that their pilot telephone health information help line was
most commonly used after work hours by women and children. This service
that connected individuals to a nurse and could be accessed from the privacy
of one’s home was found to especially help culturally and linguistically diverse
(CALD) women (primarily of Maori decent). The help line was used for general
health information and minor health conditions but was also used for directing
individuals to other health care professionals when the nurse could not
63
Sillence, E., Briggs, P., Harris, P., & Fishwick, L. (2007). “How do patients
evaluate and make use of online health information?”, Social Science &
Medicine, 64 (9), 1853-1862.
64
Atkinson, N. Saperstein, S., & Pleis, J. (2009). “Using the internet for health-
65
Wathen, C. & Harris, R. (2007) “I try to take care of it myself” How rural
women search for health information.” Qualitative Health Research, 17(5),
647.
66
Wathen, C. & Harris, R. (2007). “I try to take care of it myself” How rural
women search for health information”. Qualitative Health Research, 17(5),
639-651.
67
Waters E, Haby M, Wake M, Salmon L. (2000). “Public health and
barriers to participation.” Medical Journal of Australia, 173(2), 68-71.(only got
abstract)
68
69
Miller, C., Wakefield, M., & Roberts, L. (2003). “Uptake and effectiveness of
the Australian telephone Quiteline service in the context of a mass media
campaign”, British Medical Journal: Tobacco Control, 12, 53-58.
13
provide adequate information.70
Printed Materials & mass media texts
Printed texts and mass media health information include materials such as
newspapers, books, pamphlets and magazines targeted at women. Jones
reports that:
“The media are an important source of health information for many

women and probably influence their perceptions of susceptibility and
appropriate health-protective behaviours.”71
This is particularly true for conditions affecting women such as breast cancer,
which, good health information and early detection, have the potential to
reduce the Australian morbidity and mortality rates. However, analysis
indicates that current textual mass media in Australia, such as women’s
magazines and newspapers, are not conveying accurate, evidence based
information likely to promote healthy behaviours and adequate screening and
are instead misinforming women/leading women astray.72 Murphy & Murphy
from the Women’s Health Victoria survey found that although textual materials
are a common source of health information, more personalised channels
where women can engage with people such as GPs, family and friends, and
the Internet are preferred.73 Textual sources are, however, used at a similar
rate to the Internet, suggesting that they appeal to those who have the
education, critical thinking and level of literacy to benefit from them.74
Women’s health centres
A study from the Australian National University in the ACT, found that
Women’s Health Centres are vital service and health information providers for
Australian women. Analysis suggests their success arrises from providing or
at least assisting women to find general and specific health information,
supporting women in discerning and comprehending health information, as
well as providing an empathetic ear and adequate time to listen to complex
70
St George, I. & Cullen, M. (2001). “The Healthline pilot: call centre triage in
New Zealand”, New Zealand Medical Journal, 114(1140), 429-430. (ONLY
GOT ABSTRACT)
71
Jones, S. (2004). “Coverage of breast cancer in the Australian print media
—does advertising and editorial coverage reflect correct social marketing
messages?”, Journal of Health Communications, 9(4), 310.
72
Jones, S. (2004). “Coverage of breast cancer in the Australian print media
—does advertising and editorial coverage reflect correct social marketing
messages?”, Journal of Health Communications, 9(4), 309-325.
73
74
14
and sometimes distressing health and wellbeing issues women face.75 These
centres provide women with information and understanding beyond a
illness/disease and treatment medical model. A poignant quote highlighting
how women’s centres can help women understand health issues further was;
“If I go to the GP I feel l have to have an identifiable physical problem

whereas I would go to a women’s health centre if I wanted to discuss
more general troubling issues and wanted help in understanding
beyond a purely physical symptom “76
Women consistently report that they feel rushed seeing GPs for health and
wellbeing issues and that doctors could not provide adequate information and
explanations during their average 10-15 minute consultations. 77, 78 Women’s
Health centres can generally provide women with longer consultations or at
least give attention and opportunities to learn and have informed discussions
on health and wellbeing with other women. By providing a space for women to
discuss their health these centres promote social networking and a space for
peer learning and teaching which can provide a vital source of health
information.79 Beyond providing a store credible health information, women’s
health centres often providing links for women to access additional sources of
health information and health care to meet their specific needs.80
Family and Friends
The Women’s Health Victoria Survey found that young women particularly
prefer informal networks such as family and friends for their health
information.81 They rate these sources as their second preference despite the
recognised unreliable quality of the information from these (often) lay
sources.82 This finding, evidenced by American research suggests that
younger women may like the personalisation and/or informality of receiving
75
Broom D. (1998) “By women, for women: the continuing appeal of women’s
health centres”. Women & Health. 28(1), 5-22.
76
Broom D. (1998). “By women, for women: the continuing appeal of women’s
health centres”. Women & Health. 28(1), 14.
77
Broom D. (1998). “By women, for women: the continuing appeal of women’s
health centres”. Women & Health. 28(1), 13.
78
Murphy, M & Murphy, B. (2003). “Access to women’s Health information: A
survey of Victorian women as Information Seekers, Women’s Health Victoria,
Melbourne, 24
79
health centres”. Women & Health. 28(1) 5-22.
80
Murphy, M., Murphy, B. & Kantos, D. (2003). “Access to Women’s Health
information: A literature review of women as health information seekers”,
Women’s Health Victoria, Melbourne,15-16.
81
Victoria, Melbourne, 13,15.
82
information: A survey of Victorian women as Information Seekers”, Women’s
Health Victoria, Melbourne, 15,17,24.
15
health information from those they trust, and that ease of access and time
may be a big factor in how they access health information.83 Murphy et al.
noted the trend of young women readily accessing informal sources such as
family and friends, mass media and the Internet to find confidential
information on specific topics even though such sources are recognised as
low in quality.84 This suggests that perhaps young women are using GPs just
to confirm or dismiss the credibility of information found. Further studies
suppose that younger women primarily rely on easily accessible information
and seek institutional or qualified medical professionals as a later/last resort.
85, 86
Another Australian study by Smith et al. found that women of lower
educational or functional level were often supported by their family and friends
who sort out health information on their behalf and consequently played an
important highly informed and supportive role in their health decisions.87
Families and friends in ethnic communities of shared religious, cultural or

historical backgrounds have been found to provide a supportive network to
learn and share health information in their community.88 The literature
suggests that working with women within their community by identifying their
collective health literacy needs, validating their personal experiences and
providing a medium where they can engage in peer learning and
understanding together is highly successful for engaging with women of CALD
backgrounds.89
Pharmacists and other Allied Health professionals
Pharmacists and other allied health professionals are also useful sources of
health information reported by women.90 The Women’s Health Victoria found
83
Belle-Brown, J., Carroll, J., Boon, H. & Marmoreo, J. (2002). “Women’s
decision-making about their health care: views over the life cycle”. Patient
Education and Counseing, 48, 225-231.
84
85
639-651.
86
Women’s Health Victoria, Melbourne, 44-5.
87
Smith, S., Trevana, L., Nutbeam, D., Dixon, A., & McCaffery, K. (2009).
69, 1805-1812.
88
Women’s Health Victoria, Melbourne, 21.
89
Williams-Brown, S., Baldwin, D., & Bakos, A. (2002). “Storytelling as a
method to teach African American women breast health information”, Journal
of Cancer Education, 17 (4), 227-230.
90
16
that pharmacists were rated as second in quality of health information while
were sixth in preference as a health information source.91 This indicates that
although pharmacist and allied health remain and are acknowledged as a
useful source of health information for Australian women, they are perhaps
under utilised compared to other sources.
Other allied health professionals such as pharmacists and nurse practitioners

have shown success in being able to provide patients with more time for
health information discussions during consultations and can involve patients
more fully in their health care decisions.92, 93
Conclusion on Sources of health information
The previous Australian women’s access to health information study suggests

a combined approach where the provision of quality assured text and visual
sources of health information are used in combination with visits to
appropriate health care providers. Indeed evidence shows that repeating and
extending information previously discussed in consultations with individuals
though providing a variety of sources such as a specific pamphlets or
recommended Internet websites, greatly increases the likelihood of firstly
positive lifestyle changes, secondly, individuals taking medication as
prescribed and thirdly, the correct use of preventative screening.94
Limitations to women’s access to information
Even if women can assess quality health information not all women want
more information but would rather solely rely on their GP’s (or another health
care provider’s) opinion without question.95 A consistent limitation found in the
literature is that women become confused by the volume of unclear, and often
conflicting health information.96, 97 Indeed women report, “I’m just
639-651
91
92
93
639-651.
94
Murphy, M., Murphy B. & Kanost, D.(2003). “Access to Women’s Health
95
Education and Counseling, 48, 230.
96
Nicholson, W., Gardner, B., Grason, H., Powe, N. (2005). “The association
between women’s health information use and health care visits”. Women’s
Health issues. 15(6), 240-248.
97
17
overwhelmed,” and “It’s tough on the Internet because there’s just too many
options”98 Indeed, volume, poor quality and conflicting opinions in information
creates more problems and questions than it answers.
As discussed, there are numerous sources of health material differing greatly

in quality, type and currency. However, improvements in women’s own and
their family’s health will not happen unless certain barriers to using health
information sources are overcome. The first of these is that of health literacy;
it is important to ensure that women know how to source appropriate, quality
information, comprehend it, and apply it to their lives. The second is to
overcome barriers created by the information itself, such as it being
incomplete or unspecific and not quality assured. Finally, there are barriers to
using these sources of health information related to women’s time constraints
and women’s specific circumstances.
Education and Counseling, 48, 225-231.
98
643.
18
BARRIERS TO HEALTH INFORMAITON
There are many barriers preventing women from accessing good quality
health information. Firstly, there is the barrier of missing or unspecific health
information that does not meet women’s needs. Secondly, there is the barrier
of poor quality/ credibility undermining the usefulness of information. Thirdly,
time poverty limits information providers and seekers’ access to information.
Finally, there are particular barriers facing specific groups of women, such as
young women, CALD women, those with poor literacy, or those seeking
information on alternative therapies.
Incomplete, unspecific and overgeneralised health information
Despite the numerous sources discussed above, and the plethora of health
information available, women still report not being able to access sufficient
health information to meet their specific needs.99 Surprisingly there are few
academic studies actually examining what types of health information women
are seeking and what they feel is missing.100 These basic questions are
essential for all health information service providers to ensure they are
effective in enhancing women’s health and health literacy.
Literature indicates what women want from a health information source is

fourfold. Firstly, women want easily accessed factual information on illnesses,
but they also want general information on health and wellbeing. Secondly,
women want increased communication and personalisation of information
through discussions with health professionals and others who share similar
health and wellbeing issues. Having emotional support by being able to
discuss issues with others who understand what they are going through,
physically and emotionally, and for women to feel their opinion is respected, is
essential for good communication and making positive health decisions.
Finally, women want information to access professionals and experts in
specific fields. These four elements of an optimal health information source
are rarely found in one source.101
Health information is ineffective if it is not relevant to meet women’s needs, or

if women are unaware of their current state of health and see no use in
accessing health information. Parslow et al. reports,
“Personally relevant health information is an important factor that can

change individuals’ perceptions of their health needs.“102
99
Murphy, M. (2003). “Access to women’s Health information: Research
100
101
639-651.
102
Parslow, R., Jorm, A., Christensen, H. & Rodgers, (2004). “Use of medical
19
Women becoming more aware of the state of their health needs and risks is
essential in promoting preventative health care, such as through participation
in preventative screening. Effective programs promoting the change to a
healthier lifestyle are an important tool in reducing the burden of preventable
illness for women and society as a whole.103 In a study by Sullivan et al. early
intervention program for individuals with risk factors for strokes, reported that
the information they desire should (1) highlight the short and long term
benefits, (2) be personally relevant, and (3) be able to be applied practically.
Such findings point the way forward for other health information providers and
health education/intervention programs.104
Credibility of information sources & quality assurance
Even if women can access health information, it remains futile if the quality is
poor. It is essential, therefore, that women can have quality information if it is
to empower them to use it to positively influence their life choices. In 2003
Australian women reported the Internet, popular press and family/friends are
frequent sources of health information despite their recognised questionable,
and sometimes poor, quality.105 Reasons for this were barriers of lack of time
and difficulty in accessing more reputable sources.
Numerous studies show that the Internet is increasingly used by women to

access health information.106, 107 The Women’s Health Victoria highlighted
reasons why many women only end up with poor quality health information.108
Firstly, most women search for health information through general search
engines which return links to often thousands of irrelevant, inaccurate and
services after participation in a community-based epidemiological health

survey”. Social Psychiatry & Psychiatric Epidemiology, 39(4) 311.
103
Parslow, R., Jorm, A., Christensen, H. & Rodgers, (2004). “Use of medical
services after participation in a community-based epidemiological health
survey”. Social Psychiatry & Psychiatric Epidemiology, 39(4) 311-317.
104
Sullivan, K.,White, K., Young, R., Scott, C. & Mulgrew, K. (2008).
“Developing a stroke intervention program: what do people at risk of stroke
want?”, Patient Education & Counseling, 70(1), 126-134. – ONLY GOT
ABSTRACT-
105
Victoria, Melbourne, 17-18.
106
107
Scandinavian Journal of Public Health, 35(5), 533-539.
108
Murphy, M., Murphy, B. & Kanost, D. (2003). “A Literature Review of
Women as information seekers”, Women’s Health Victoria, Melbourne.
20
outdated websites.109, 110 Secondly, many of these websites found are
commercial, selling ‘medical’ products that have not undergone double-blind
randomised controlled trials, essential for medical quality assurance.111
Instead, many of these sites rely instead on fraudulent claims and consumer
testimonials.112 Frustration at conflicting information and the marketing agenda
of information sources has been found to be a problem for women making
decisions about hormone replacement or natural therapies in women going
through menopause.113 Issues of quality assurance are particularly concerning
considering that some studies analysed showed that women (in the face of
barriers in accessing other sources) sometimes relied upon the Internet to
diagnose and treat any illnesses.114
Literature including the Women’s Health Victoria showed that many women
are unable or unsure of how to check the credibility of a website and report
varying degrees of trust in the quality of internet information.115 If women
continue to search for health information on the Internet, criteria to help them
think critically about what they are reading is vital.116
Current literature indicates that the Internet is not a reliable source of patient
information for some health issues. For example, a survey of the quality of
websites providing health information on laparoscopy from popular search
engines showed that out of 14 030 hits only 46 contained specific educational
material and, when critically analysed, as many as 32 of these contained
misleading, controversial health information. This leaves a highly unlikely
approximately 0.099% chance of women looking on the Internet this way to
109
110
Warner, D. & Procaccino, J.D. (2004) “Towards Wellness: Women seeking
111
112
113
Alfred, A., Esterman, A., Farmer, E., Pilotto, L. & Weston, K. (2006).
“Women’s decision making at menopause; a focus group study”. Australian
Family Physician, 35(4), 270-272.
114
Harris, R., & Wathen, N., (2007) ““If My Mother was Alive I’d Probably
Have Called Her.” Women’s Search for Health Information in Rural Canada”.
Reference and user services quarterly, 47(1), 67-79.
115
116
21
find accurate health information about this specific treatment.117
A consistent barrier in women accessing quality assured health information

from the Internet is that many women are unaware of medically endorsed,
quality assured websites, such as Medline.118 In Australia there are numerous
medically endorsed websites e.g. NHIMAC, Healthinsite, The Better Health
Channel( a Victorian Government website), The ABC Health & Wellbeing
information portal and Informed Health Online. Through the Internet
international websites such as MayoClinic.com, the British Medical
Journal, OncoLink (for sound breast cancer information) and
MEDLINEplus, are well endorsed quality assured websites free to
public use. 119 However, such sites may be underutilized as a survey
by The Australian Family Physician in 2006 found that’
“most women are unaware of existing reliable websites and call

centres”.120
A related problem for many (especially older) women is their inexperience

navigating the World Wide Web, further complicating effective use of this
medium.121
The mass media and popular press also lack the quality of information
needed by women to make positive health decisions. Several studies have
highlighted how women’s magazines rarely focus on complicated issues
significant to women and long-term health information. Rather than promoting
positive health choices they tend to be more focused on weight loss (in rapid,
sometimes unhealthy ways) and beautification.122
Time poverty for both info providers and women
117
Allen, J., Finch, R., Coleman, M., Nathenson, L., O’Rouke, N. & Fielding,
G. (2001). “The poor quality of information about laparoscopy on the World
wide web as indexed by popular search engines”. Surgical Endoscopy, 16,
170-172.
118
Warner, D. & Procaccino, J.D. (2004) “Towards Wellness: Women seeking
119
Fry, R. (2001). “Elixer of E-health”. Found at:
http://www.abc.net.au/health/consumerguides/stories/2001/08/09/1837359.ht
m
120
Women’s decision making at menopause; a focus group study. Australian
121
Behaviour of access of the Internet: a study of women attending a breast
Informatics, 77(1), 24-32.
122
22
As discussed in the GP service provider section, lack of time is the leading
barrier GPs give for providing patients with quality health information.123, 124
Additional research shows that health care providers are more likely to give
health information to patients who ask for it, however, given that many
patients already feel rush while seeing their GP it is likely that many feel
unable to take up extra time and ask such questions.125 Some women even
report limiting their consultation time or search for information, to prevent
“taking up too much of their doctor’s time when other patients were waiting to
be seen”.126 Thus, the strain of time poverty is directly affecting their access to
health information.
There is currently little literature on women’s lack of time and how it impacts
on women’s health and health literacy. This is a promising area of research
given the negative ramifications of lack of time. What is known is that women
lack sufficient time to put their health as a priority. For example, the main
barrier Kontos et al. found for women not accessing the to improve their
health/internet literacy skills was lack of time due to work and family
responsibilities.127
Time constraints often mean health information is delivered as a one-way

factual transfer from health care providers to patients. This is less effective
than a two-way dialogue where women actively develop their own decision-
making, and practical skills for looking after their own and their families
health.128 Only providing factual information is a short-term bandage for
improving women’s health as, unless it can be applied practically, information
is easily forgotten. Helping women to develop their health literacy by
increasing consultation time, and investing time in women to ensure they can
access, understand, and use quality health information is a much sounder
long-term approach.129
123
Murphy, M., Murphy B. & Kanost, D.(2003), Access to Women’s Health
Providers, Women’s Health Victoria, Melbourne, 6.
124
Waters E, Haby M, Wake M, Salmon L. (2000). “Public health and
barriers to participation”. Medical Journal of Australia,173 (2):68-71.(only got
abstract)
125
126
640.
127
home computer and Internet use among urban novice computer users of low
128
Renkert, S. & Nutbeam, D. (2001). “Opportunities to improve maternal
health literacy through antenatal education: an exploratory study”. Health
Promotion International, 16(4), 381-388.
129
Adams, R., Stocks, N., Wilson, D. & Hill, C. (2009). “Health literacy a new
concept for general practice?”, Australian Family Physician, 38(3), 144-147.
23
Women’s recall under pressure/stress
Another barrier scarcely discussed in current discourse is the fact that under
stressful conditions, such as when one is in hospital or has an acute health
condition, their ability to recall verbal information given by health care
providers significantly reduces. This finding increases and is especially true
for older women. Given that many women have competing health concerns
and pressures, and they must juggle and manage family members health as
well, not being able to recall once given health information is unsurprising.130 It
is essential therefore that important health information provided to women
while they are under stress or in acute situations, is also provided in a take-
home written and visual format. If this cannot be done, health care providers
must inform women of ways to access the information again. For example
they could provide pamphlets recommending reputable websites with the
same information (or even extending upon it in more depth) for women to
refer to and be able to apply later.
BARRIERS FOR SPECIFIC GROUPS OF WOMEN
Young women and confidentiality
Confidentially was highlighted as one of three major barriers facing women’s

access to health information found in the previous Women’s Health Victoria,
access to women’s health information reports. 131, 132 Confidentiality was
particularly an issue for younger women seeking information from health care
providers (eg GP’s) about sexual health and pregnancy matters eg on
Sexually Transmitted Infections (STI’s) and drug/substance-use information.
133
Feeling unable to get the confidentiality on sensitive issues they require,
research shows young women utilise reputable sources such GP’s less, in
favour of selected family, peers, the Internet and mass media sources with
whom they feel can more confident. 134
Incarcerated women and specific health needs
Geographical and situational factors mean some women are unable to access
mainstream health information sources. For example incarcerated women
130
Rushford, N., Murphy, B., Worcester, M., Goble, A., Higgins, R., LeGrande,
M., Rada, J. & Elliot, P. (2007) “Recall of information received in hospital by
female cardiac patients”. European Journal of Cardiovascular Prevention &
Rehabilitation. 14(3), 463-469.
131
132
Murphy, M (2003) “Access to women’s Health information: Research
133
134
Murphy, M (2003) Access to women’s Health information: Research
Summary, Women’s Health Victoria, Melbourne.
24
have specific health information needs. One study of women in prisons
reported great success in providing a radio channel for women promoting
healthy living and wellbeing, positive mental health, and harm minimisation
strategies. The success of the channel arose from meeting an otherwise
unmet need, as women were encouraged to participate in the station by
sending in questions on health and wellbeing topics they wanted discussed.
This resulted in shared benefits for the source providers (knowing their
service was appropriate and beneficial), and for the women actively engaging
in health promotion and receiving the relevant health information they
desired.135
Women seeking alternative non-western or medical health information
Some women believe GPs stand in the way of accessing non-medicalised or

non-westernise health information. Indeed studies report women feeling
dismissed when their GP is reluctant to consider or provide information on
alternate health care therapies. Indeed some women believe GP’s are narrow
minded, never accepting or even considering alternative health options136
These women believe the over medicalisaiton of health is a barrier to the way
they want their health to be managed and undermines their autonomy in
choosing their health and treatment options in natural again. 137
Given the increasing trend of women seeking alternative options to manage

their health and wellbeing, GP’s need to be better resourced in how to
respond to women who want to find alternate information. Whether or not they
help women confirm or dismiss the credibility of they information they should
be at least be prepared to discuss (among themselves) the influence of
alternative therapies on many women’s lives, and, with the women how (like
any source), to critically analyse any information they find.
Seeking non medical/alternate advice is especially prominent for issues such

as menopause with many women not wanting to go down a ‘disease/
treatment’ path. Instead many women would rather view menopause as a
natural progression and stage in their life in which they want to find out more
health information about alternative treatments and basic lifestyle changes.138
Marginalised groups of women, with poor access to services or English

135
Minc, A., Butler, T. & Gahan, G. (2007). “Jailbreak Health Project-
incorporating a unique radio program for prisoners”. International Journal of
Drug Policy. 18(5)444-6.
136
Wathen, N & Harris, R. (2006). “An examination of the health information
seeking experiences of women in rural Ontario, Canada”, Information
Research, 11(4), 1-11.
137
Research, 11(4), 1-11.
138
25
literacy and comprehension skills
Sufficient literacy and comprehension skills are vital for women accessing and
utilising health information. If women are illiterate they are unable to read and
comprehend textual health information drastically limiting the utility of most
sources and the positive ramifications of good health information.139
Inadequate literacy and comprehension is also faced by women with whom
English is a second language such as for many Culturally And Linguistically
Diverse (CALD) women. Access to health information for CALD women will be
discussed specifically later, but a major barrier to their improved health in
Australia is because of inadequate materials and interpreters to meet the
language acquisition and comprehension needs of these women.140 141
The Women’s’ Health Victoria Survey noted that women from CALD or
indigenous backgrounds often couldn’t find linguistically appropriate
information. Evidence shows marginalised women, especially those in poverty
have significantly reduced ease of access to major sources of health
information such as the internet.142 This is particularly concerning considering
marginalised women consistently have poorer health, education, socio-
economic status and service utilisation compared to other Australian women,
all detrimental risk factors for their ever increasing poorer health and
wellbeing.143
139
140
141
142
A survey of Victorian women as Information Seekers” , Women’s Health
143
Summary, Women’s Health Victoria, Melbourne, 8.
26
TRENDS OF HEALTH INFORMAITON ACCESS FOR DIFFERING GROUPS
OF WOMEN
It is well acknowledged that specific groups of women have differing health

and health information needs.144 This brief overview examines the health
information needs and trends of specific groups of women in the ACT, such
as culturally and linguistically diverse women (CALD), Indigenous women,
women with disabilities, women with mental health concerns, young women,
elderly women, pregnant women, carers, and women with multiple health
concerns.
Culturally and Linguistically Diverse Women
In order for CALD women in the ACT to access health services and maintain
a good level of health they require specific services to access health
information. The Women’s Health Victoria 2003 literature review and survey
highlighted two major issues CALD women face, and recommended two ways
improve information access for these women.145
Firstly, the issues of concern were that health information accessible to these
women was often not culturally appropriate, and that CALD women were
under utilised existing services through which they could access more health
information/ health care.146 Indeed, the overall survey results showed
dissatisfaction with access to quality of health information was primarily a
concern of women who had English as a second language.147 Additionally,
issues of health care provider assumptions and prejudices have arisen as a
barrier facing CALD women in receiving adequate health information.
Avenues for improvement in CALD services showed women prefer to receive

health information in a one-to-one manner from a trusted person rather than
being given a translated information pack. The Internet was also highlighted
an increasing avenue of linguistically appropriate health information and
support.148
144
145
Women’s Health Victoria, Melbourne, 46-7
146
Women’s Health Victoria, Melbourne, ,47
147
Melbourne, 28.
148
Women’s Health Victoria, Melbourne, ,47
27
In 2004, a study by Simonian’s et al. focused on how to effectively convey
health information to ‘women of colour’. The findings were unsurprising but
significant: that CALD women respond more readily to health information that
is aimed at their ethnicity and demographic. If women can receive information
that discusses the health concerns of similar women and how they make use
of health services they are more likely to realise their own health risks and
respond by making positive health choices, such as participating in breast
cancer screening.149
Narrative based information and storytelling is another way to engage CALD

women with health information. Williams-Brown et al. highlighted that using
story-telling could connect CALD women to service providers, correct
misinformation, enhance peer learning about health concerns and validate
personal experiences.150 This method is another way to make health
information more specific to particular groups of women and thus more
accessible, relevant and successful in promoting women’s health and
wellbeing.
Research from the Australian Health Review indicates that immigrants often
have significant unaddressed health needs.151 Indeed, Temple-Smith et al.
found that 77% reported outstanding, unaddressed health problems despite
63% already having consulted a health care provider in Australia. Lack of
interpreters and lack of appropriate information on health services they could
utilise were cited as the reasons for these unaddressed problems. 152 This
appears to be an international trend with other peer-reviewed studies showing
a lack of culturally and linguistically diverse health information.153
Finally, an issue of concern which has been discussed more freely in recent
years, is that of discrimination, insensitivity, and prejudice from health care
providers when working with women from CALD backgrounds. Canadian
research on the experience of Muslim migrants found that women experience
discrimination when accessing the healthcare system. Not only did they face a
149
Simonian, K., Brown, S., Sanders, D., Kidd, C., Murillo, V., Garcia, R. &
Marks, S. (2004). “Breast health information: messages that appeal to young
women and older women of colour”. Journal of Cancer Education, 19(4), 232-
6.
150
Williams-Brown, Baldwin, D. & Bakos, A. (2002). “Storytelling as a method
to teach African American women breast health information”. Journal of
Caner Educaiton, 17(4), 227-230.
151
Cooke, R., Murry, S., Carapetis, J., Rice, J., Mulholland, N. & Skull, S.
(2004) “Demographics and utilisation of health services by pediatric refugees
from East Africa: implications for service planning and provision”. Australian
Health Review, 27 (2), 40-45.
152
Cooke, R., Murry, S., Carapetis, J., Rice, J., Mulholland, N. & Skull, S.
(2004) “Demographics and utilisation of health services by pediatric refugees
from East Africa: implications for service planning and provision”. Australian
Health Review, 27 (2), 40-45.
153
Reitmanova, S. & Gustafson, D. (2008). “They can’t understand it”:
maternity health and care needs of immigrant Muslim women in St. John’s,
Newfoundland. Maternal and Child Health Journal, 12(1),101-111.
28
significant lack of culturally and linguistically appropriate material (when
accessing maternity services) they also encountered prejudice and
stereotyping.154 Such ill-treatment of women is unacceptable, and highlights
the need for an improvement of CALD services and training for health care
providers.
Indigenous women
Indigenous women are subject to disadvantage from many directions.

Generally, indigenous women have a lower socio-economic status, poorer
health, lower utilisation of healthcare services, greater morbidity of
preventable illness, lower educational attainment and poorer access to health
information.155, 156 Thus, Indigenous women are particularly in need of
improved health literacy and access to quality health information. This brings
into focus the need to improve literacy and comprehension levels among this
group of women and the importance of the provision of easy to understand,
verbal, or highly visual information.157
There is evidence that health care and information providers can successfully
engage with Indigenous women. For example one Australian study which
responded to previously unaddressed issues such as risk factors for chronic
illness and climacteric (i.e. menopausal) symptoms. The success of the
project arose from collaborating with local Indigenous elders and artists to
help provide appropriate health information materials which was translated
into traditional and vernacular language and was culturally sensitive to
indigenous women’s needs.158 Such a method of collaboration to improve
health provider trust within the community, connect women to service
providers, and produce health information (on health promotion) has the
potential to benefit other marginalised groups of women.
Women with Disabilities
Disabilities are generally defined as any restriction, limitation or lack, resulting

in impairment to perform normal activities of daily living, likely to last for at
154
Reitmanova, S. & Gustafson, D. (2008). “They can’t understand it”:
maternity health and care needs of immigrant Muslim women in St. John’s,
Newfoundland. Maternal and Child Health Journal, 12(1),101-111.
155
Women’s Health Victoria, Melbourne, 45-6
156
Summary, Women’s Health Victoria, Melbourne, 7-9.
157
158
Davis, S, Knight, S., White, V., Claridge, C., Davis, B. & Bell, R. (2003).
“Climacteric symptoms among indigenous Australian women and a model for
the use of culturally relevenat art in health promotion”. Menopause. 10(4)345-
351. (ONLY GOT ABSTRACT)
29
least six months.159 In 2003 the Australian Bureau of Statics found that the
disability rate in the ACT was 16% of the population and that:
“One in five people in Australia (3,958,300 or 20%) had a reported

disability in 2003... Of those with a reported disability, 86% (3,387,900)
were limited in the core activities of self care, mobility or
communication, or restricted in schooling or employment.”160
There is also a high percentage of the Indigenous community with a

disability.161 There is significant research indicating that although individuals
with a disability have greater needs in accessing health care and health
information, they face more disadvantage and significant barriers in
attempting to do so. 162 For example, women with visual impairment expressed
frustration “that most educational materials about health issues that concern
them were written materials, rendering them useless.”163 Disabled women also
identified negative stereotyping from health care providers and short
consultation times were an issue of concern. These women often reported
feeling depersonalised and burdensome to health care providers, especially
when doctors were unable to provide facilities or advice to meet their needs.
When it becomes too difficult for women with disabilities to access local health
services for appropriate health information, the Internet often turned to as a
source of disability specific information.164 However, on the Internet
information is not presented by a person (which has been found to be more
effective) and there are questions of quality assurance and potential harm.165
159
Australian Bureau of Statistics (2003). (4430.0) “Disability, Aging and
Carers, Australia: Summary of Findings, 2003”. Australian Bureau of
Statistics, Canberra. Found at:
http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4430.0Main+Features1
2003?OpenDocument
160
Australian Bureau of Statistics (2003). (4430.0) “Disability, Aging and
Carers, Australia: Summary of Findings, 2003”. Australian Bureau of
Statistics, Canberra. Found at:
http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4430.0Main+Features1
2003?OpenDocument
161
162
McColl, M., Forster, D., Hunter, D., Dorland, J., Goodwin, M. & Rosser, W.
(2008) “Physician Experience Providing Primary Care to People with
Disabilities”, Health Care Policy, 4(1), e129-147.
163
Smeltzer, S., Sharts-Hopko, N., Ott, B., Zimmerman, V., & Duffin, J. (2007)
“Perspectives of Women with Disabilities on Reaching Those Who Are Hard
to Reach”, Journal of Neuroscience Nursing. 39 (3), 167.
164
165
Summary”, Women’s Health Victoria, Melbourne, 8-9.
30
Young Women
The Women’s Health Victoria literature review on women as information

seekers highlighted that the main issue for young women seeking health
information is confidentiality,166 with survey results showing that young women
used family and friends, mass media and the Internet far more than older
women.167 The Journal of Medical Ethics provides an example of the research
around confidentiality issues deterring young people from consulting their
GPs. They found that as adolescent girls mature they are increasingly
concerned about the confidentiality of what they discuss with service
providers and are consequently reluctant to consult their physician for health
care and information. This is epically true if young women want to discuss
sensitive issues such as sexual health, contraception, bullying, depression
and the misuse of illicit drugs.168 Such research indicates that young women
would rather go without quality information than face the risk of having their
confidence on sensitive issues broken. Perhaps confidentiality and reluctance
to see GPs contributes to why young women are the leading seekers of health
information from the Internet.169
Older Women
In Australia in 2003, older women reported significant problems with, and

concerns around, accessing health information, especially on issues specific
to their needs such as menopause (and hormone replacement therapy).170
Inadequate access to information needed was especially hard for older
women who did not have dependent children (to help them access the
Internet) or who were unwell, living alone, or less educated.171, 172
Older women are generally more dependent on their primary health care
provider, less autonomous, and less assertive than younger women. As a
result they consult their GP more frequently to meet their health information
166
Women as Information Seekers”, Women’s Health Victoria, Melbourne,44-5
167
168
Carlisle, J., Shickle, D., Cork, M. & McDonagh, A. (2006). “Concerns over
confidentiality may deter adolescents from consulting their doctors. A
qualitative exploration”. Journal of Medical Ethics, 23(3), 133-137.
169
Santana, S., Staniszewski, A. & Wangberg, S. (2008). “eHealth trends in
170
Murphy, M., Murphy, B. & Kanost, D. (2003) “A Literature Review of
Women as Information Seekers”, Women’s Health Victoria, Melbourne,45.
171
Women as Information Seekers”, Women’s Health Victoria, Melbourne,45.
172
31
and health care needs.173, 174 Older women, however, continue to frequently
turn to family, friends and other women who share health issues to find health
information from a trustworthy sensitive source when they can not find it from
mainstream sources.175,176
Pregnant women/mothers
Not all groups of women face barriers in accessing health information specific
to their needs. Mothers and pregnant women generally report good access to
health information from a variety of sources. These women often use
maternal, family and children’s health services to a greater degree and
through having children have many opportunities to hone their skills of
accessing and applying health literature to meet their needs. Correlating with
having dependent children is an increased likelihood of access to the Internet
and the health literature available on it.177
Carers
The Women’s Health Victoria studies highlighted two major barriers for
women who are carers to access appropriate quality health information. The
first was due to the fact that many female carers who seek information on
behalf of individuals with poor health/ a disability greatly prefer to access
health information through discussing it one-on-one with a GP or support
service. This limits the sources of health information available to personalised
mediums, and, given the GP/women’s time pressures, means carers may not
be getting health information they require to meet their and their family’s
health care needs.178
Women with multiple health issues
Finally, literature shows that some women have a combination of health

problems or other issues which marginalise them in society, such as those
from CALD backgrounds, the illiterate, and those with mental health issues. It
is hard for these marginalised women to find health information and services
addressing the combination of their specific needs. These women consistently
173
Women as Information Seekers”, Women’s Health Victoria, Melbourne, 45.
174
Victoria, Melbourne 15, 29.
175
639-651.
176
Murphy, M., Murphy, B. & Kanost, D. (2003) A Literature Review of
Women as Information Seekers, Women’s Health Victoria, Melbourne,45.
177
Murphy, M. & Murphy, B. (2003). Access to Women’s Health information:
A survey of Victorian women as Information Seekers, Women’s Health
178
Women as Information Seekers”, Women’s Health Victoria, Melbourne, 47.
32
slip through health care gaps.
33
HEALTH LITERACY
Understanding Health literacy
Health literacy has been defined as,
“the degree to which individuals have the capacity to obtain, process

and understand basic health information and services to make
appropriate health decisions.”179
Health literacy affects all aspects of health knowledge and health care. Its
influences reach from being individuals able to navigate through the health
care system, to accessing and understanding health prevention, screening,
diagnosis and treatment options to adequately meet one’s current and future
needs.180 Health literacy also encompasses a sound understanding of ones
own health, health risks and needs in order to know what is appropriate health
information to utilise.181 There is also evidence of “a strong association
between health literacy and self-efficacy” with respect to some women’s
health issues (such as decision making on hormone replacement therapy).
Adequate health literacy to know what one can do to improve health, and
good self-efficacy, to have the knowledge and belief in oneself to make any
needed changes, has huge ramifications for optimising women’s health
outcomes.182
Australia’s health literacy deficiency
The Department of Health and Aging recently reported that 60% of

Australians lack the basic health literacy skills to acquire, understand and use
health information needed to meet everyday needs.183 In terms of improving
the national level of health literacy, and applying it, Australia trails behind
other western countries.184 Therefore, programs to improve individual’s health
literacy through education need to be developed.
179
Institute of Medicine (2004), as cited in, Smith, S., Dixon, A., Trevena, L.,
Nutbeam, D. & McCaffery, K. (2009). “Exploring patient involvement in
healthcare decision making across different education and functional health
literacy groups”. Social Science & Medicine, 69, 1806.
180
Torres, R. & Marks, R. (2009). “Relationships among health literacy,
knowledge about hormone therapy, self efficacy and decision making among
postmenopausal health”. Journal of Health Communication, 14(1)43-55.
181
182
Torres, R. & Marks, R. (2009).. “Relationships among health literacy,
183
Nutbeam, D. (2009) “Building health literacy in Australia”, Medical Journal
of Australia, 191(10), 525-6.
184
34
Improved health literacy does not just mean providing women with more
health information, as information alone will not promote lasting behaviour
changes.185 Instead, health literacy is needed to engage with the health
information, empower women to understand it, make decisions that promote
health, engage in health prevention strategies, access health services and
encourage a positive and healthy attitude.186
Benefits of good health literacy
There is consistent evidence in the literature analysed that indicates how

good health literacy promotes positive lifestyle choices and health
outcomes.187, 188 Research indicates that health literacy is vital if individuals
are going to engage with preventative health care and take active measures
to reduce their risk of preventable illness.189 Individuals need to understand
and evaluate complex health information and be autonomous decision makers
given many women’s current time pressures.190
Practical applications of health literacy include being able to read medical

documents (such as consent forms or medication instructions),191 knowing
when and how one should go about being screened for disease,192 knowing
when bodily functions are symptomatic of ill health, and knowing how and
where to seek necessary health care assistance.193, 194 Research shows low
185
Renkert, S. & Nutbeam, D. (2001) “Opportunities to improve maternal
186
VonWagner, C., Knight, K., Steptoe, A., & Wardle, J. (2007). “Functional
heath literacy and health promoting behaviour in a national sample of British
adults”. Journal of Epidemiology & Community Health, 61(12), 1089.
187
Nutbeam, D. (2009). “Building health literacy in Australia”, Medical Journal
of Australia, 191(10), 525-6.
188
189
190
69, 1805-1812
191
Hardyman, R., Hardy, P., Brodie, J., Stephens, R. (2005) “It’s Good to Talk
Comparison of a Telephone help line and website for cancer information”.
Patient Education and Counselling, 57, 315-320.
192
Torres, R. & Marks, R. (2009). “Relationships among health literacy,,
postmenopausal health. Journal of Health Communication, 14(1)43-55.
193
194
Renkert, S. & Nutbeam, D. (2001) “Opportunities to improve maternal
35
health literacy reduces individual’s understanding of their health, compliance
with health plans, and results in poorer management of their health.195
A sufficient degree of health literacy also allows individuals to communicate

with health care providers in a more balanced and informed manner.
Interviews with women indicate that low health literacy is linked to worsened
interactions with health care providers.196 Low health literacy means patient’s
can be overwhelmed by doctor’s language,197 do not feel respected for what
information/ understanding they do have, and feel patronised.198 Women want
more opportunities to weigh up options, be informed and make decisions
regarding all details of their health and wellbeing. Knowledge is power, and
improving health literacy allows patients to be independent managers of their
health.
Good health literacy ensures that women can engage in productive

conversations with their health care providers. This helps the GP/patient
relationship to be one of trust and mutual respect, allows for the negotiation of
health care decisions, and equalises the sharing the power and responsibility
for maximising women’s health.199 Improved health literacy has also been
shown to improve patient satisfaction.200 The Women’s Health Victoria briefly
touched on the necessity for women to have a certain level of health literacy
to understand health care professionals, and ask appropriate questions.201
This is especially true in the twenty first century given the increasing time
constraints.202 Australia carries a huge burden of chronic and preventable
illness, and a lot more preventative work could be done if Australian’s health
literacy was improved.203
195
postmenopausal health”. Journal of Health Communication, 14(1)43-55
196
197
198
639-651.
199
69, 1805-1812.
200
201
202
postmenopausal health”. Journal of Health Communication, 14(1), 43-55.
203
Oldroyd J, Proudfoot J, Infante F., Davies, G., Bubner, T., Holton, C.,
36
Detriments of poor health literacy
One study found that low health literacy in pregnant women resulted in
reduced self-efficacy to cope with pregnancy, the birth of their child and
subsequently poorer health and wellbeing outcomes for the mother and child.
204
International research consistently indicates low health literacy is linked to

poorer physical and psychological health and results in higher morbidity and
mortality. 205 Recent Japanese research indicates that, even after adjusting for
socio-economic status, engagement in risky health behaviours, and chronic
health conditions, having low health literacy was still significantly correlated
with lower reported physical and psychological health and wellbeing.206 Low
health literacy has huge ramifications for an individual’s future health and use
of health care services as a whole. For example, low health literacy has been
associated with a poor understanding of one’s own health (and the prevention
of chronic illnesses), less use of preventative health strategies (such as
vaccinations and screening), reduced use of primary health services, reduced
likelihood of taking medications as prescribed, poor self-care, reduced ability
to interact and engage with health care providers, a greater cost and burden
on health care services and finally higher mortality.207 Thus, the long-term
ramifications of poor health literacy will not only drastically impede upon the
health of individual women, but will also influence the future health of the
nation.208, 209
Demographically, poor health literacy increases with age, low educational

level and low income.210 Men generally have poorer health literacy than
Beibly, J., & Harris, F. (2003). “Providing healthcare for people with chronic
illness: the views of Australian GPs” Medical Journal of Australia, 179, 30-33.
204
205
Tokuda, Y. Doba, N., Butler, J., Paasche-Orlow, M. (2009). “Health literacy
and psysical and psychological wellbeing in Japanese adults”, Patient
206
207
208
Exploring patient involvement in healthcare decision making across different
education and functional health literacy groups. Social Science & Medicine,
69, 1805-1812.
209
Nutbeam, D. (2009) “Building health literacy in Australia”, Medical Journal
of Australia, 191(10), 525-6.
210
37
women, however, regardless of gender, education, ethnicity, age and income,
better health literacy still significantly increases women’s self-rated level of
health, and the chance of engaging in daily health promoting behaviours.211
This is an important point for effective health promotion as it clearly shows
poor health literacy is part of a complex tapestry of disadvantage which
remains unaddressed in Australia.212
Limitations of health literacy
The limitations to improving health literacy are similar to those of providing

health information sources for women to access. That is, even given sources,
understanding, and opportunities to use health information, time poverty or
the priority women place on health may limit its success. Even if women
achieve high levels of health literacy they can still be overwhelmed with too
much heath information and become confused.213 Another limitation is that
many women are given health information that is only factual rather than
increasing their health literacy and decision making skills.214 While this
provides women with access to health information it is only a small part of
health literacy and the understanding, using and empowering of women to be
masters of their health is what is vital. As recommended later, possibilities to
address this are numerous, such as following the UK’s trials of adult
education programs to develop adults’ health literacy skills and work out how
to apply quality health information to their lives.215

211
212
213
Wathen, N & Harris, R. (2006) “An examination of the health information
Research, 11(4), 4.
214
215
of Australia, 191(10), 525-6.
38
VALIDITY OF IMPROVING WOMEN’S ACCESS TO HEALTH
INFORMATION IN THE ACT
Women report lack of information
In 2003 the Women’s Health Victoria survey revealed that 30% of women
report poor access to health information, or were unsure if health information
they could access was adequate to meet their needs. This suggests that
many women, while not completely dissatisfied with information they can
access are not completely satisfied.216 Further evidence from the United
States suggests that women are especially articulating their desire for detailed
health information. A study by Ziegler et al. found that 76% of 2500 adults
using an outpatient clinic reported they wanted more information from their
GPs concerning possible adverse effects of medications.217 Of particular
concern is that women who have lower physical, psychological and social
health report a great lack and greater difficulty in accessing quality health
information to begin to meet their needs.218
Women are the main source of health information for themselves and
their family
Across the globe, and for hundreds, if not thousands of years, considerable
evidence suggests that women are the primary managers and decision-
makers of their and their family’s health and wellbeing needs.219, 220, 221 Across
their lifespan, women are acknowledged as the largest group seeking health
information222and utilising healthcare services.223 Women use a combination of
216
217
218
Arora, N., Johnson, P., Gustafson, D., McTavish, F., Hawkins, R., &
Pingree, S. (2002). “Barriers to information access, perceived health
competence, and psychosocial health outcomes: to test a medication model in
a breast cancer sample”. Patient Education & Counselling, 47(1), 37-46.
219
Warner, D. & Procaccino, J. (2004). “Towards Wellness: Women Seeking
220
Wathen, N & Harris, R. (2006) “An examination of the health information
Research, 11(4), 1-11
221
Pandey, S., Hart, J. & Tiwary, S. (2003) “Women’s health and the Internet:
understanding emerging trends and implications”, Social Science & Medicine,
56, 179-191.
222
Warner, D. & Procaccino, J. (2004). “Towards Wellness: Women Seeking
223
Pandey, S., Hart, J. & Tiwary, S. (2003) “Women’s health and the internet:
understanding emerging trends and implications”, Social Science & Medicine,
39
both active and passive sources to find health information to meet their and
their family’s needs.224 Further research also indicates that women are often
the catalyst in young men’s (i.e. their boyfriends) lives to improve their health
by encouraging self-awareness of their health, the effective use of health
services, and by helping them to access appropriate health information.225
Women are expressing a desire to access better health information
Recent years has seen a huge increase in pressure on individuals to be more

responsible for their health, especially to reduce risk factors for preventative
health conditions and remain active participants in society.226 With this
increased responsibility many women have expressed a desire to take a more
active role in the decision-making process.227 Analysis of current literature
consistently shows that women want to be more active participants in health
information seeking and the decision making process.228 The only way to
make well-informed choices and be ‘responsible consumers’ is though
accessing, comprehending, and discussing quality health information with
their peers and health care providers.229
Improved decision making and communication
Studies suggest those who participate in health decision have better health
outcomes and many women report they want more involvement in this
process.230 Despite the fact that women surveyed desired a shared decision
making process, 50% of patients believed their doctor and made the main
health decision and 35% believed the physician had not taken their opinion
seriously.231 Giving women more and better quality health information
56, 179-191.
224
women search for health information. Qualitative Health Research, 17(5),
639-651.
225
Marcell, A., Howard, T., Plowden, K. & Watson, C. (2009). “Exploring
Women’s perceptions about their role in supporting partners’ and sons’
reproductive health care”. American Journal of Men’s Health, 5(11), 1-9.(23)
226
education and functional health literacy groups”. Social science & Medicine,
69, 1805-1812.
227
228
Warner, D & Procaccino, J. (2007). “Women seeking health information:
distinguishing the web user”. Journal of Health Communication, 12(8), 787-
814.
229
Education and Counseling, 48 (3), 225-231.
230
of Australia, 191(10), 525-6.
231
Stewart, D., Abbey, S., Shanek, Z. Irvine, J., Grace, S. (2004). “Gender
40
increases the likelihood of effective communication with health care providers
and inturn optimises shared decision making. 232 Strong evidence shows that
many Australian women want more health information from health care
providers on treatment options, costs, alternative therapies, and possible
adverse effects.233 Patients who actively participate in the decision making
process have been found to have better outcomes than those who are more
passive.234
Multiple mediums of health information
One study suggests that women who have suffered a heart attack reported
receiving less health information for their recovery trajectory. This could be a
result of prejudice giving men more factual information, or could be that
women under pressure may remember the information less clearly then men,
or what information women are given simply seems inadequate to what they
feel they ought to know.235 This brings to light the role of providing information
in both verbal and written forms, as health care providers seek to increase the
self-efficacy and satisfaction of the patients. The Women’s Health Victoria
confirmed this observation, finding printed information combined with a health
care consult substantially increases patient’s uptake of healthy lifestyle
choices. This combined approach should be used more widely to improve
screening and medication compliance.236
Government responsibility for a climate of patient autonomy
If governments want to reduce the burden of chronic and preventable

illnesses on society they must recognise that they need to provide the
resources for people to manage their own self care, engage in preventative
differences in health information needs and decisional preferences in patients

recovering from an acute ischemic coronary event” Psychosomatic Medicine,
66, 47.
232
Warner, D & Procaccino, J. (2007). “Women seeking health information:
distinguishing the web user”. Journal of Health Communication, 12(8), 787-
814.
233
234
Stewart, D., Abbey, S., Shanek, Z. Irvine, J., Grace, S. (2004) “Gender
differences in health information needs and decisional preferences in patients
recovering from an acute ischemic coronary event”, Psychosomatic Medicine,
66, 42-48.
235
M., Rada, J. & Elliot, P. (2007). “Recall of information received in hospital by
236
41
health care measures, and make positive lifestyle choices.237 Education has
been an important part of health promotion strategies in the 20th century,
however, it is important to extend this by actively seeking to improve women’s
autonomy with regards to making informed health care decisions.238 One way
to do this would be to not only increase access individual’s access to health
information and health literacy. For example, the A healthier future for all
Australians 2009 report suggests encouraging engagement by including
health literacy as a core element of the National Curriculum for schools,
setting the agenda for “an agile and self-improving health care system”.239
237
Research, 11(4), 1-11.
238
Nuttbeam, D. (2000) “Health literacy as a public health goal: a challenge
for contemporary health education and communication strategies into the 21st
century” Health Promotion International, 15.3, 259-267.
239
National Health and Hospitals Reform Comission. (2009) A healthier future
for all Australians Final Report of the National Health and Hospitals Reform
Commission – June 2009. Commonwealth of Australia, Canberra, 7.
42
RECOMMENDATIONS
Numerous recommendations were made in the articles reviewed. Many

focused on specific channels of health information or the needs of particular
groups. Some have the potential to help improve Australian women’s health
literacy and access to good quality, current health information to meet their
needs.
Valuing women’s access to health information
Firstly, it is essential that health care providers and governments recognise

the value of improving women’s access to, and comprehension of, health
information. Women desire better access to quality health information to
improve their, and their family’s, health and wellbeing.240 Thus, improving
quality access to health information and health literacy has the potential to
greatly improve the health of women in the ACT, especially where preventable
or treatable diseases are concerned. This is confirmed through several
recommendations that women be autonomous, and for health care providers
to listen to, and work with women, sharing information.241 Valuing women’s
health literacy means a change from the patriarchal GP/patient relationship to
one that promotes mutual sharing of information and active autonomy.
Increasing patient knowledge of health matters (making them more informed

or more misinformed) and increasing patient autonomy, has been a major
reason GPs are sometimes reluctant to promote health literacy. It also affects
the traditional Doctor/patient relationship and how health decisions are made.
To ensure that doctors are not faced with misinformed patients questioning
their ability to understand and discern what evidence based health
information, GPs and other health care providers must promote public access
to quality assured health information sources (such as endorsed websites).
Doctors could also mediate and help individuals to learn to discern and
critically analyse health information they find.242 243
Provide multiple quality sources concurrently
An important finding of this literature review is that providing quality health

information concurrently in a number of different formats improves the recall,
use, and its application to women’s lives. This is particularly crucial when
240
241
242
243
43
women are under acute stress as verbal health information concerning long-
term issues may easily be forgotten.244 Thus, Rushford et al. recommends that
providing additional sources of information (as well as telling patients) during
acute events and rehabilitation is critical to promote health and wellbeing.245
Research also points to advantages in using a combined approach by health
care providers, using additional media such as pamphlets, books or
websites.246
Giving women multiple sources increases their autonomy, allowing them

greater ability to select what information they utilise. This is already being
done in rural Canada, with women reporting:
“I don’t think I can point out just one [source]. I think it’s a combination
of things…I kind of take the advice that I get from all of those and see
what suits… in the end I’m the one that has to make the choices to
what is best for my family” 247
Providing multiple sources of information is especially valuable during

consults, diagnosis, and at life transitions such as pregnancy, retirement, or
the loss of a loved one.248
Any health information source or health education program must combine (1)
practical applications to individual’s lives (2) transfer of information in a
personalised manner and (3) be provided in combination with health care
provider services. Although the Internet provides a range of quality health
information materials it lack the personalised contact. However, some
evidence is beginning to indicate that online support groups could provide the
emotional support, encourage women and reduce isolation during illness.249
Make health care providers and individuals aware of information
sources’ limitations
244
245
246
247
Research, 11(4), 1-11.
248
249
Hardyman, R., Hardy, P., Brodie, J., Stephens, R. (2005) “It’s Good to Talk
Comparison of a Telephone help line and website for cancer information”.
Patient Education and Counselling, 57, 315-320.
44
All sources of health information have their limitations and none completely
meet the health literacy needs of all women. Awareness of the potential for
good and harm from the Internet is paramount given its continued rise in
popularity as a health information channel.250 This further heightens the need
for Internet websites to accommodate for a range of audience levels of
literacy and confidence. There is huge potential for harm as search engines
lead individuals to disreputable, outdated or commercial information.251
Australia needs tighter regulation of products and services that make claims
to improve individual’s health, particularly for the sale of products that have
not undergone independent double-blind placebo tests. This will ensure that
the trust between medical and alternative health care providers remains
unblemished and patient’s health is not compromised.
Provide authoritative endorsements of quality websites
One way to do this, recommended by many of the articles reviewed, is to

have government, or other authoritative organisations, such as Breast Cancer
Australia, endorse reliable and accurate health information sources/websites
such as the BreastScreen NSW website.252, 253 One suggestion is that the
Australian Medical Association or Government health bodies could create a
brand or seal to make endorsed websites easily identifiable to those seeking
health information from the internet.
In order that these endorsed health information websites continue to provide

quality health information, they must be intensively monitored and managed.
This would require resources to ensure information is kept up to date with
current health research and are protected from outside interference. For the
success of government and (reputable) organisational recommended
websites it would also be essential to have these sites well publicised to
health care providers and the public.254
250
Santana, S., Staniszewski, A. & Wangberg, S. (2008) eHealth trends in
Europe 2005-2007:a population-based survey, Journal of Medical Internet
251
home computer and internet use among urban novice computer users of low
252
Behaviour of access of the internet: a study of women attending a breast
Informatics, 77(1), 24-32.
253
Cowan, C. & Hoskins, R. (2007) Information preferences of women
receiving chemotherapy for breast cancer, European Journal of Cancer Care,
16(6), 543-550.
254
45
The US suggests that Internet moderators are vital to ensure quality
information. In some countries (and in Victoria) intensive monitoring and
promotion of some reputable websites already are already underway through
some government health information portals.255
Improve the personalisation of health information to make it more

specific to individuals needs
Personal stories of others who come from a similar demographic, or of whom

are going through a similar health or illness trajectory, help to personalise
health information. This increases women’s connectedness with others
reducing the isolation felt by many when facing illness. Listening to personal
stories also has been shown to help women be more proactive in asking
questions of their health providers, or confirming the trust they place in health
care providers.256 Physical and online groups should be set-up and supported
(e.g. through subsidised meeting facilities or web space).
Health information sources must recognise that their effectiveness can be

improved if they provide relevant, practical applications, not simply a factual
monologue.
Health care providers being mediators in individual’s health literacy
Health care providers should be more proactive in preventative health through

helping individuals improve their own health literacy.257 This could be done (1)
though community courses to help individuals improve their health literacy,258
online, (2) through multimedia tutorials (on how to find reputable information
sources and not be lead into commercial sites), (3) through telephone hotlines
(providing direction on how to access health information), or (4) though heath
care providers, such as nurse practitioners, sitting down with women and
holistically assessing their needs and together finding quality, up-to-date
sources.259, 260 ,261Such interactive health information programs may begin to
255
Research, 11(4), 1-11.
256
Sillence, E., Briggs, P., Harris, P., & Fishwick, L. (2007) How do patients
evaluate and make use of online health information? Social Science &
Medicine, 64 (9), 1853-1862.
257
Nutbeam, D. (2001). “ Health literacy as a public health goal: a challenge
century. Health Promotion International, 15(3), 259-267.
258
259
260
of Australia, 191(10), 525-6.
261
Sullivan, K.,White, K., Young, R., Scott, C. & Mulgrew, K. (2008).
46
help fill the need women have voiced in sorting the multitude of information.
262
The success of such nurse run programs have been in providing an

empathetic, understanding ear when information is found and helping women
to rate the credibility of sources and general advice and refereeing of women
to other sources or health care providers if they are unsure.263
Another way to improve the nations health literacy, and engagement in

preventative health care, is through providing GPs with incentives to spend
sufficient time developing these skills in their patients. Given the current
medical system, time is money, and lack of time and remuneration means
health care providers are not (consistently making or) encouraged to make
long term investments in their patients. A way to change this would be to
restructure how GPs are payed. Given a sufficient salary means GPs would
have little reason to rush patients though and could embrace the benefits of
helping individuals improve their health literacy though assisting with their
access to, comprehension of, and application of quality health materials in
their lives. This has the potential to drastically reduce the burden on the
tertiary health care system in the future.
Promote health literacy in other public forums
Previous research has noted the potential for public libraries or GP/hospital
libraries to help provide training and support in health literacy needs.264, 265
Such libraries could serve as portals for individuals to access information in a
variety of formats (e.g. pamphlets, books, visual or audio materials) or
sources recommended by their GP or the Australian Medical Association.
Small Australian pilot trials showed women were the greatest uses, and 98%
of borrowers found the item “useful” or “very useful” and had increased their
knowledge, decreased anxiety or changed their behaviours in a positive way.
The GPs in such trials felt positively towards having the information libraries
as they could “save time explaining complex conditions” and it was useful to
reinforce messages, increase patient understanding, and provide further
depth.266 However, problems have arisen when doctors feel patients know
“Developing a stroke intervention program: what do people at risk of stroke
want?”, Patient Education & Counseling, 70(1), 126-134. – ONLY GOT
ABSTRACT(don’t really need- you can delete)
262
Mason, M. (2008). “Listening to women’s problems”. Nursing Standard, 23-
29; 22(46), 24-25.
263
St George, I. & Cullen, M. (2001). “The Healthline pilot: call centre triage in
New Zealand”, New Zealand Medical Journal, 114(1140), 429-430. (ONLY
GOT ABSTRACT- can use Mason above if cant get)
264
Charlton, I. (1997.) “Usefulness of a patient library in a suburban general
practice”, Medical Journal of Australia, 167,579-581.
265
Harris, R., & Wathen., N. (2006). “If my mother was alive I’d probably have
called her”: women’s search for health information in rural Canada, Reference
& User Services Quarterly, 47(1), 67-79.
266
practice”, Medical Journal of Australia, 167,579-581.
47
more about a particular health concern than themselves.267
Promote individuals to improve their health awareness and health

literacy
Finally, evidence shows that increasingly patients must take more

responsibility for their health with an eye both now and to the future. To do
this individuals must be aware of the impact of good health literacy can have
on their lives and be encouraged to become more literate in health matters.
Engagement with health information has repeatedly been shown to improve
health outcomes.
Improving national health literacy
It is vital to monitor national health literacy and explore ways to improve it.
Developing health literacy is often not a priority for busy Australian women.
Changing this mindset and helping people to see the benefits of improved
health literacy and positive lifestyle change is a challenge. Public relations
and marketing campaigns either showing the consequences of ignoring one’s
health (literacy) or the benefits of developing this skill are one way of making
health literacy a national priority. Some research suggests that given the
ramifications of good or poor health literacy, it should be added as a social
determinant of one’s health 268.
It encouraging to see the Australian government taking action to place health

literacy as “a core element” of the new National Curriculum for schools.269 It is
hoped that this will not simply focus on facts but teach students to critically
analyse any health information and apply it (or not) to their lives. School
health literacy programs would a prime opportunity to counter misconceptions
about lack of GP confidentiality for young women. Further research needs to
be done on young people’s existing health information usage patterns.
Help should also be given to service/information providers to simplify their

education materials and improve communication with those of poorer health
literacy.270 Further research to understand women’s current health literacy,
what information is missing and how they comprehend and apply it is a must.
Current health education programs, such as antenatal classes, can be

improved by finding out the difference between what health information
267
practice”, Medical Journal of Australia, 167,579-581
268
269
National Health and Hospitals Reform Commission. (2009). “A healthier
future for all Australians Final Report of the National Health and Hospitals
Reform Commission – June 2009”. Commonwealth of Australia, Canberra, 7.
270
48
providers think they give and what women report as receiving. Not simply
providing more factual information but helping to develop women’s decision
making skills and practical applications of health and wellbeing information is
a more long-term solution271.
Of particular in Australia is the health of indigenous women, particularly those

who are illiterate. Providing materials in local languages, more visual forms
and health care providers who are trained to help indigenous women find,
comprehend and utilise these materials essential if indigenous population
health is to be improved. Coordinating with indigenous elders to identify and
meet the needs of communities is the first step.
Another way to ensure programs to reduce the risk of preventable illness and
promote healthy lifestyle choices are utilised is to renumerate women who
participate. The structure for this already exists through Centrelink’s skill
development programs for the unemployed. Investing in such strategies may
appear initially costly, but considering the burden of chronic illness of the
tertiary health care system, it may represent a long-term saving.
Need to change the GP/patient relationship
There is a great need to change the GP/patient relationship to one of mutual

power, respect, and responsibility. Increasingly GPs recognise that their role
is not simply to operate in a treatment paradigm but to managing their natural
progression of health changes. Lee & Garvin’s research highlights how the
transfer of information in a hierarchical one-way manner is insufficient to
change individual recipients’ health outcomes. Instead it is essential that
health care providers attempt to engage with patients and exchange
information in a more balanced two-way dialogue.272 One study at diabetic’s
care plans showed far better results for those who took an active part in
making health decisions.273
Where there is still debate among experts, health care providers are best
served by being honest with patients, providing them with the most current
recommendations while acknowledging uncertainty. For example, issues such
as the debate around hormone replacement therapy for menopausal
women.274
Longer GP consultation times was a consistent recommendation, despite

271
272
Lee, R. & Gavrvin (2003) “Moving from information transfer to information
exchange in health and health care”, Social Science & Medicine, 56, 449-464.
273
Elwyn, G., Edwards, A., Kinnersley, P. (1999) “Shared decision making in
primary care: the neglected half of the consultation”. British Journal of
General Practice, 49, 478.
274
Family Physician, 35(4), 270.
49
being costly.275 The British Journal of General Practice highlighted that a
consultation which included the elements of (1) the provision of clear
information (2) clarification and questioning from the patient (3) willingness to
share and discuss decisions, and (4) agreement between the GP and patient
about the problem and plan represents the benchmark for good general
practice consultations in the 21st century.276 Considering time constraints, and
lack of reimbursement are leading causes for GPs not providing adequate
health information the Government should investigate increasing connotation
time or restructuring Medicare incentives to promote preventative health care.
There is also a need for research into women’s and health care provider’s
time poverty and its negative ramifications on health.
Another major recommendation for health care providers is for them to

improve their training for responding to CALD women’s needs. This needs to
cover a philosophy of tolerance towards cultural difference as well as relevant
specific studies of cultures. An investment in translation services and
engaging health care providers from CALD backgrounds to help liase is also
likely to have a positive outcome for these marginalised groups. Creating
scholarships for Australians and immigrants (for health care degrees) for
those from language groups and ethnicities currently under represented in the
health care system would be one good investment in ensuring the health care
system can meet the needs of a multicultural Australia.
A continually unaddressed barrier for disabled women is the lack of disability

friendly buildings and transport to get to such places which can provide health
information and services to meet their needs.
The Role of Women’s Health Centres
Research indicated that the demand for women’s health centres will increase
in the future given the fact that they give women the personal contact, trust
and time women need to discuss sensitive health issues.277 The benefits of
women’s health centres are in that they provide a service unlike the treatment
oriented acute health care system, and are more focused on providing more
generalised more generalised health information being aware of the holistic
picture of women’s circumstances and social context. While the centres
cannot always hope to meet the specific needs of women they encounter they
are well placed to provide referrals to other local health services and
information.
Women’s health centres could provide another medium for providing health
and Internet literacy skills. This could be done by having classes and trained
275
General Practice, 49, 477-482.
276
General Practice, 49, 478.
277
Mason, M. (2008) “Listening to women’s problems”. Nursing Standard, 23-
29; 22(46), 24-25.
50
staff able to help women navigate the web and go about finding reputable
sites. Older women could especially benefit from such programs, which could
build their confidence in other sources of health information rather than relying
solely on expensive and time pressured GP consults.
51
CONCLUDING COMMENTS
Executive Summary
The major findings of this literature review were;
• • Women are active seekers of health information for themselves and

their families.
• • Women find health information from a variety of sources, including
GPs, family and friends, pharmacists, the Internet and mass media.
• • GPs are the preferred source of health information for Australian
women
• • The Internet is increasingly being used as a convenient and
inexpensive health information source, particularly by young women.
• • While the Internet is awash with health literature, most women’s
awareness of its limitations and ability to source credible sites remains
imperfect.
• • There remain groups of women with specific difficulties in accessing
information to meet their needs (eg those with English as a second
language)
• • There are many barriers undermining the value of health information,
e.g. unspecific overgeneralised information, illiteracy, women’s time
poverty etc.
• • The need to improve women’s health literacy is paramount given the
ramifications for individual’s in applying health information effectively
The major recommendations were;
• • Increased valuing of women’s access to health information.

• • A change in the GP/patient relationship from one-way provision of
information to one where women are active participants in their health
care decisions.
• • Health care expenditure needs to prioritise health literacy,
preventative health care and the time for contact between patients and
health care providers
• • Existing sources of quality health information need to be better
publicised such as medically endorsed websites. These also need to
be kept up to date with current evidence based literature.
• • Changes need to be made to the provision of health information to
ensure it is understood, acted upon and effective.
• Health literacy needs to be promoted in individuals and in public forums
and its long-term impact on improving the health of individuals and
reducing the burden of the acute medical system needs to be made
know.
• • Specific attention needs to be given to reducing barriers and
increasing access to health information for marginalised groups of
women
• The continued role and value of Women’s Health Centres as mediums
for women to access information and improve their health literacy skills.
52
Conclusion
Significant research as discussed in this literature review highlights the

deficiency in women’s access to health information and the importance of
improving this situation. While brief, it is hoped this literature review will
stimulate discussion about how this could be done in the Australian context.
While research on the ACT is lacking, women from the area could provide a
good population for a pilot study in improving health literacy and women’s
access to health information. In the past women’s health literacy and access
to health information has been undervalued, but, such a study could provide
further confirmation of its importance in reducing the burden of preventable
and chronic illness on the health care system and optimising women’s health
and wellbeing.
53

Final Literature Review

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LITERATURE REVIEW ON WOMEN’S ACCESS TO HEALTH

TRENDS AND PREFERENCES IN ACCESSING SOURCES OF HEALTH INFORMATION . 5

Incarcerated women and specific health needs...................................................................................24

IMPROVING NATIONAL HEALTH LITERACY..............................................48

THE ROLE OF WOMEN’S HEALTH CENTRES............................................50

The Women’s Centre for Health Matters (WHCM) is a community-based

There are a number of reasons it is important to understand how women

Secondly, it is vital for women to be able to access quality health information

Fourthly, understanding the sources of health information used, and preferred

• To provide evidence based literature to help analyse and discuss the

Boundaries of the review

Methodology for Literature Review

TRENDS AND PREFERENCES IN ACCESSING SOURCES OF HEALTH

A major finding of the Women’s Health Victoria Survey of Women’s Access to

The trend of women’s preference for the GP to provide individuals with

It is unsurprising then that despite the preference for GPs to provide

Consistent research indicates that Internet usage is dramatically increasing

Consistent academic evidence suggests that although the Internet trend is

Although young women use the Internet readily there is an increasing

Telephone Help Lines

In Australia, telephone help lines are a minor source of health information

Printed Materials & mass media texts

“The media are an important source of health information for many

Women’s health centres

“If I go to the GP I feel l have to have an identifiable physical problem

Family and Friends

Families and friends in ethnic communities of shared religious, cultural or

Pharmacists and other Allied Health professionals

Other allied health professionals such as pharmacists and nurse practitioners

Conclusion on Sources of health information

The previous Australian women’s access to health information study suggests

Limitations to women’s access to information

As discussed, there are numerous sources of health material differing greatly

Incomplete, unspecific and overgeneralised health information

Literature indicates what women want from a health information source is

Health information is ineffective if it is not relevant to meet women’s needs, or

“Personally relevant health information is an important factor that can

Credibility of information sources & quality assurance

Numerous studies show that the Internet is increasingly used by women to

services after participation in a community-based epidemiological health

A consistent barrier in women accessing quality assured health information

“most women are unaware of existing reliable websites and call

A related problem for many (especially older) women is their inexperience

Time poverty for both info providers and women

Time constraints often mean health information is delivered as a one-way

BARRIERS FOR SPECIFIC GROUPS OF WOMEN

Young women and confidentiality

Confidentially was highlighted as one of three major barriers facing women’s

Incarcerated women and specific health needs

Women seeking alternative non-western or medical health information

Some women believe GPs stand in the way of accessing non-medicalised or

Given the increasing trend of women seeking alternative options to manage

Seeking non medical/alternate advice is especially prominent for issues such

Marginalised groups of women, with poor access to services or English

It is well acknowledged that specific groups of women have differing health

Culturally and Linguistically Diverse Women

Avenues for improvement in CALD services showed women prefer to receive

Narrative based information and storytelling is another way to engage CALD

Indigenous women are subject to disadvantage from many directions.

Women with Disabilities

Disabilities are generally defined as any restriction, limitation or lack, resulting

“One in five people in Australia (3,958,300 or 20%) had a reported

There is also a high percentage of the Indigenous community with a