National Institutes of Health Usage and Attitudes Study

1. National Institutes of Health Usage and Attitudes Study

2. Key Questions • Are health information seekers aware of NIH’s research mission? If so, to what degree? • How satisfied are health information seekers with the quality of NIH health content? • How satisfied are health information seekers with the breadth and depth of health topics covered by NIH? • Do health information seekers have different expectations for the NIH Health Information Pages than they do for commercial health Web sites? • What is the context and relationship of the NIH Health Information Pages to other major health resources on the Web? • Do health information seekers have differing expectations for coverage of individual health topics? • Is there a higher degree of satisfaction with content quality for health information seekers who understand the NIH mission? • Is there a higher degree of satisfaction with the breadth and depth of health topics covered for health information seekers who understand the NIH mission?

3. Survey Methodology • Email survey fielded to Nielsen//NetRatings MegaPanel January, 2004 • 35% response rate • Weighted n = 1,095 • Data weighted against NetView Health Category, based on Age, Income and Gender • Clickstream data based on MegaPanel usage behavior October, November, December, 2004

4. Agenda • Key Findings • Online Health Market Overview • Health Website Trust Factors • NIH Visitor Profile • The NIH “Message” • NIH Content Quality • Potential Next Steps

5. Key Findings • Trust is clearly a key component to which sites consumers visit for health content. Because trust and brand awareness are so closely linked online, it is likely that NIH could increase visitors trust of their content simply through online brand awareness campaign. • Since health visitors find new sites mostly through search engines and links from other respected sites, it may be most effective to develop deeper partnerships with respected health related sites to further develop brand awareness. Additionally, paid placement on search engines may be a relatively quick and effective way of building awareness and traffic. • Clearly, building traffic should be a key goal for NIH, users who have visited NIH in the past month have a significantly better opinion of the quality of NIH content and have a much better understanding of NIH’s core message. Since consumers who have not visited NIH recently tend to look to non-search online advertising as a way to find new health sites, NIH may be able to reach this new audience through targeted ad buys on relevant health sites. • NIH is doing an adequate job conveying it’s message to health content consumers. Improving the messaging is key for long-term success of NIH.gov. Visitors who understand the message are much more likely to be satisfied with NIH and their behavior also suggests they use the content more often and more effectively. • NIH should also look to improve content quality in specific target areas. Overall site quality lags far behind WebMD. Specifically, NIH should improve it’s arthritis, stroke, hearing loss and diabetes content in order to meet health consumer demand.

6. Online Health Market Overview • Beyond WebMD, the consumer health market online is extremely fragmented. When given an open ended question and asked to list which health content providers they visited in the past 30 days, 73% of respondents listed health sites that were listed by fewer than 9 other respondents. • Not surprisingly, WebMD resonates most with visitors, with 91% of their visitors remembering they had visited the site in the past 30 days. Only 50% of NIH visitors remember their visit. • Site design is seen as not important to health site visitors. This matches well with data from other verticals, which suggest that visitors have come to expect a minimum level of design quality on professional sites. Significant advances above that design tend not to be seen as critical. • The more common the condition, the more frequent the search. Health category users tend to search for more common ailments, while SIDS and Schizophrenia tend to be searched for less often. • Search engines and links from sites and online articles are the most popular way to find new health content. Only about 20% of Health category users say they find new content through online advertising, suggesting key word buys on search engines may be a more effective way of advertising health content than other types of traditional media buys.

7. Health Category Usage Metrics NetRatings NetView run of selected heath sites. January 2005

8. Beyond WebMD Online Health Content Is Fragmented Q: In the spaces below please list the health related websites you have visited in the past 30 days. NetRatings MegaPanel Survey (2/05) n = 1,095

9. Approximately 50% of NIH’s Visitors Forget That They Have Visited NIH.gov Metric: Memory gap analysis shows the percent of visitors who visited a site in the past 30 days that remember visiting. NetRatings MegaPanel Survey (2/05) sample varies by site

10. Appearance and Diagnosis Are Not Important Factors Q: When you use a site to research health topics, what is important to you? Please rate the following characteristics on a 1 to 5 scale, where 1 means "Not important" and 5 means "Very important." <<Not Important Important>> 2% 29% 2% 10% 2% 2% 1% 2% 2% NetRatings MegaPanel Survey (2/05) n = 1,095

11. Common Chronic Conditions Are Searched For Most Often Q: Which of the following health topics have you researched online in the past 6 months? NetRatings MegaPanel Survey (2/05) n = 1,095

12. Search Engine Placement and Site Partnerships Draw in New Visitors Q: In The Past Six Months, Which Of The Following Ways Have You Found Out About Websites? NetRatings MegaPanel Survey (2/05) n = 1,095

13. Health Website Trust Factors • 73% of Health category users trust WebMD for specific content they are looking for. 53% would trust NIH. Given the difference in overall brand recognition this difference is not shocking, and is likely not related to the overall quality of NIH’s content. • NIH’s goal of being a source for information on specific conditions that are being actively researched does seem to resonate with the respondents, with 73% trusting NIH for content on HIV/AIDs and 67% trusting NIH for Schizophrenia content. • Visitors do not necessarily look to the same site to provide all of their health related content. For example, visitors look to pharma sites for conditions related to specific drugs, portal sites for asthma or government sites for hearing loss.

14. WebMD Is By Far The Most Trusted Health Information Website Q: Which of the following sites' research would you trust for the health topics you selected? NetRatings MegaPanel Survey (2/05) n = 1,095

15. Broadly, NIH’s Goal of Covering Research “Medical Condition” Seems To Be Met Q: Which of the following sites' research (NIH) would you trust for the health topics you selected? NetRatings MegaPanel Survey (2/05) n = 1,095

16. WebMD Is Highly Trusted Across The Board Q: Which of the following sites' research (WebMD) would you trust for the health topics you selected? NetRatings MegaPanel Survey (2/05) n = 1,095

17. Broadly, WebMD’s Coverage is Seen As More Trustworthy Than NIH Metric: Gap analysis between NIH and WebMD trust. Gap analysis measures the difference of WebMD from NIH. Negative values show the number of NIH percentage points below WebMD. Those values that are positive show the number of NIH percentage points above WebMD. NetRatings MegaPanel Survey (2/05) n = 1,095

18. Beyond Glaucoma, Users Have Little Trust For Pharma Sites Q: Which of the following sites' research (Pharma) would you trust for the health topics you selected? NetRatings MegaPanel Survey (2/05) n = 1,095

19. NIH Attracts Visitors Through HIV/AIDs and Alzheimer’s Searches Q: Which of the following sites (NIH) did you visit to research the health topics you selected? NetRatings MegaPanel Survey (2/05) sample varies by condition

20. WebMD Attracts Users Looking for Multiple Health Topics Q: Which of the following sites (WebMD) did you visit to research the health topics you selected? NetRatings MegaPanel Survey (2/05) sample varies by condition

21. General .gov and .org Sites Attract Visitors Looking For Cognitive Disorders Q: Which of the following sites (.gov/.org) did you visit to research the health topics you selected? NetRatings MegaPanel Survey (2/05) sample varies by condition

22. Pharma Company Sites Attract Users Looking For Product Specific Information Q: Which of the following sites (Pharma) did you visit to research the health topics you selected? NetRatings MegaPanel Survey (2/05) sample varies by condition

23. Visitors Go to General Portals To Find Widely Available Information Q: Which of the following sites (General Portal) did you visit to research the health topics you selected? NetRatings MegaPanel Survey (2/05) sample varies by condition

24. Conditions With Greatest Gaps In Trust Percent Health Users Who Trust Site

25. NIH Visitor Profile • In general NIH users tend to find health content similarly to the online population, however, they are less likely to click through internet advertisements than other groups. Since almost a quarter of health content users who have not visited NIH do look to online advertising to find out about new health content, traditional online advertising (i.e. banner ads etc.) maybe an efficient way to tap into a new audience. • Overall, NIH users have higher expectations for the health sites that they visit than non-NIH visitors. They are less likely to find self diagnosis and site design important. • Visitors who believe that NIH’s content is less than optimal, also tend to visit Yahoo! Health more. This skew reinforces the fact that NIH is successful in their mission in presenting higher quality content, rather than the syndicated content of Yahoo! Health. • NIH visitors tend to research more topics than non-NIH visitors. Non-NIH visitors tend to research acid reflux and high blood pressure more than NIH visitors. Visitors who research these two areas appear to be using Pharma sites for researching these areas.

26. Almost A Quarter of Non-NIH Visitors Look To Online Advertising As A Means To Find Out About New Health Sites NetRatings MegaPanel Survey (2/05) NIH Visitor n = 193, Non-NIH n= 901

27. NIH Visitors Are Less Interested In Aesthetics and Diagnosis NetRatings MegaPanel Survey (2/05) NIH Visitor n = 193, Non-NIH n= 901

28. NIH Visitors Who Are Displeased With NIH Content Visit Yahoo! Health More Often Metric 1: Mean of the quality scores for all areas of content coverage Metric 2: Actual visitation to websites in past 30 days NetRatings MegaPanel Survey (2/05) High Quality n = 496, Low Quality n= 382

29. In General NIH Visitors Believe The Conditions Will Have A Greater Life Impact Note: In this study, “life impact” was used as a proxy for importance of coverage NetRatings MegaPanel Survey (2/05) NIH Visitor n = 193, Non-NIH n= 901

30. NIH Visitors Tend To Research More Topics Than Other Groups Q: In the past 6 months, which of the following subject areas have you researched? NetRatings MegaPanel Survey (2/05) NIH Visitor n = 193, Non-NIH n= 901

31. The NIH “Message” • NIH is doing an adequate job conveying it’s message to health content consumers. WebMD is by far leading the industry in its ability to explain to visitors what it’s mission is. • Understanding of the NIH message creates three distinct groups of health content consumers. Individuals with a low understanding tend to have the lowest level of education and income. Consumers with a high level of understanding tend to be better educated with a higher income. The middle group distinguishes itself by having the youngest audience profile. Additionally, overall satisfaction with the site is strongly correlated with understanding of the NIH mission.

32. NIH’s Message is Clearer Than Most, But Lags Behind WebMD Success of Mission Metric: This metric is the percent of users who would trust a site to find the specific health information they were looking for minus those that would not trust the site. Therefore a negative number suggest that more users would not trust a site and a positive number would trust a site. NetRatings MegaPanel Survey (2/05) n = 1,095

33. Not All NIH Visitors Are The Same: Understanding The NIH Message Low Understanding Mid Understanding High Understanding Moderate Age Lower Income Lowest Education Average Gender Split Youngest Age Moderate Income Moderate Education Above Average Female Oldest Age Highest Income Highest Education Average Gender Split 32% 38% 30% NetRatings MegaPanel Survey (2/05) Low n = 218, Mid n = 261, High n = 207

34. Those Who Understand NIH Best, Do Not Use It For Diagnosis NetRatings MegaPanel Survey (2/05) Low n = 218, Mid n = 261, High n = 207

35. Overall Satisfaction is Determined Greatly By Mission Understanding 1% 2% 7% NetRatings MegaPanel Survey (2/05) Low n = 218, Mid n = 261, High n = 207

36. Good Understanding Of NIH Leads To More Time on Target Pages NetRatings MegaPanel Survey (2/05) Low n = 218, Mid n = 261, High n = 207

37. NIH Content Quality • NIH should improve it’s arthritis, stroke, hearing loss and diabetes content in order to meet health consumer demand. • 63% of health consumers see the quality of NIH’s content level as high. WebMD is the industry leader with 80% of health consumers perceiving it’s content quality as high. • Recent visitation to NIH.gov significantly effects visitors perception of content quality, with 80% of recent visitors saying the content quality is high. • Perceived content quality is highly correlated with site usage metrics. Visitors who believe that NIH has high quality content view more pages, take part in more sessions and spend more time on NIH.gov than those who are less satisfied with the content quality.

38. In General, NIH is Meeting The Demands Of The Online Health Population Mean Content Areas To Focus On Life Impact Score (Top 7 Box) Under Invested High Demand Mean Over Invested Low Demand NIH Quality Score (Top 2 Box)

39. Health Content Users Perceive Quality Of WebMD’s Content To Be Significantly Better Metric: Mean of the quality scores for all areas of content coverage 33% 22% 80% 63% 47% 41% 1% 1% 2% 1% NetRatings MegaPanel Survey (2/05) n = 879

40. NIH Areas On Content Strength and Weakness <<Low Quality High Quality of Coverage>> 20% 10% 0% NetRatings MegaPanel Survey (2/05) sample varies by condition

41. WebMD Areas On Content Strength and Weakness <<Low Quality High Quality of Coverage>> 30% 20% 10% 0% NetRatings MegaPanel Survey (2/05) sample varies by condition

42. Recent Visitors Have A Higher Perception Of Quality Than Others Metric: Mean of the quality scores for all areas of content coverage 36% 19% 86% 56% 50% 37% 1% 2% 1% 1% NetRatings MegaPanel Survey (2/05) n = 879

43. Those Who Have Visited NIH See The Content As Much Better Than Those Who Have Not NetRatings MegaPanel Survey (2/05) NIH Visitor n = 193, Non-NIH n= 901

44. Perceived Quality Leads To Dramatically Different Content Use Overall Health Category NIH WebMD NetRatings MegaPanel Survey (2/05) NIH High Quality n = 548, Low Quality n= 330

45. Visitors Who Believe That NIH’s Content is High Quality Spend 13 More Minutes Per Month NetRatings MegaPanel Survey (2/05) NIH High Quality n = 548, Low Quality n= 330

46. Potential Next Steps • Developing an outreach strategy • Advertising strategy • Partnership strategy • Refining NIH.gov’s message in a way that better resonates with health content users • Strengthen arthritis, stroke, hearing loss and diabetes content to meet health consumer demand

47. Thanks! Jon Gibs Senior Project Manager jgibs@netratings.com