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Informed citizen and empowered citizen in health: results from an European survey

Silvina Santana1*, Berthold Lausen2, Maria Bujnowska-Fedak3, Catherine E Chronaki4, Hans-Ulrich Prokosch5 and Rolf Wynn6

Author Affiliations

1 Institute of Electronics Engineering and Telematics of Aveiro and Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal

2 Department of Mathematical Sciences, University of Essex, Colchester, UK

3 Department of Family Medicine, Wrocław Medical University, Wrocław, Poland

4 Institute of Computer Science, Foundation for Research & Technology-Hellas (FORTH), Heraklion, Crete, Greece

5 Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany

6 Institute of Clinical Medicine (FT), University of Tromsø, Norway and Division of Substance Abuse and Specialized Psychiatry, University Hospital of North Norway, Tromsø, Norway

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BMC Family Practice 2011, 12:20  doi:10.1186/1471-2296-12-20

Published: 16 April 2011



The knowledge about the relationship between health-related activities on the Internet (i.e. informed citizens) and individuals' control over their own experiences of health or illness (i.e. empowered citizens) is valuable but scarce. In this paper, we investigate the correlation between four ways of using the Internet for information on health or illness and citizens attitudes and behaviours toward health professionals and health systems and establish the profile of empowered eHealth citizens in Europe.


Data was collected during April and May 2007 (N = 7022), through computer-assisted telephone interviews (CATI). Respondents from Denmark, Germany, Greece, Latvia, Norway, Poland and Portugal participated in the survey. The profiles were generated using logistic regressions and are based on: a) socio-demographic and health information, b) the level of use of health-related online services, c) the level of use of the Internet to get health information to decide whether to consult a health professional, prepare for a medical appointment and assess its outcome, and d) the impact of online health information on citizens' attitudes and behavior towards health professionals and health systems.


Citizens using the Internet to decide whether to consult a health professional or to get a second opinion are likely to be frequent visitors of health sites, active participants of online health forums and recurrent buyers of medicines and other health related products online, while only infrequent epatients, visiting doctors they have never met face-to-face. Participation in online health communities seems to be related with more inquisitive and autonomous patients.


The profiles of empowered eHealth citizens in Europe are situational and country dependent. The number of Europeans using the Internet to get health information to help them deal with a consultation is raising and having access to online health information seems to be associated with growing number of inquisitive and self-reliant patients. Doctors are increasingly likely to experience consultations with knowledgeable and empowered patients, who will challenge them in various ways.