Experiences with searching for information about pension documents on the Internet

An important area of health care is advance planning for medical emergencies, which can be regulated individually through precautionary documents. Precautionary documents such as living wills and health care power of attorney can be drawn up by all adults and are well known among the population, but are still poorly represented in younger age groups (IfD Allensbach 2014). The topic is complex and addresses medical, ethical and legal aspects. There are also misconceptions about pension documents. This can contribute to fear of contact and prevent careful individual precautions in the event of an emergency. Even in samples in which a high prevalence of existing precautionary documents can be found, uncertainties are identified with regard to their precise creation and application (Elmeadawy et al. 2017). The Internet is an increasingly important source of information for citizens on health issues.

>> According to a representative survey, around 2/3 of citizens in Germany specifically research health information on the Internet (Schaeffer et al. 2021). Various digital information offerings can also be found about pension documents, including: Websites of ministries and private organizations, health portals, forums and communities, with varying information quality and user-friendliness (Stuart 2017). A British study that assessed the quality of online information about advance directives using several measurement instruments found that only one of 34 websites analyzed met the criteria of suitability, user orientation and effectiveness (Stuart 2017). This poses particular challenges for readers who have to evaluate the information available. Studies on digital health literacy show the difficulties in assessing health information, particularly the trustworthiness and neutrality of information in the digital space. Older people (86.0%) and people with chronic illnesses (77.1%) report greater problems (Schaeffer et al. 2021). Precautionary documents are particularly relevant for these population groups due to the more frequent occurrence of medical emergencies in old age.
To date, there has been little research into the use of information about pension documents available online. Due to the increased importance of (information) offerings on the Internet, it can be assumed that the Internet also plays an important role in obtaining information in the area of precautionary documentation and that there are difficulties in assessing the information found.
Research questions
The data is part of a larger study on the level of knowledge about pension documents in the city and district of Würzburg (Fleischmann et al. in review). The focus of this evaluation is the following questions:
1. To what extent do the respondents use online information offerings about pension documents? What information are you looking for?
2. How do the respondents experience their own search for information on the Internet?
method
The data collection took place as part of a non-representative cross-sectional study via questionnaire (online and print) in the Würzburg/Mainfranken region between July and December 2021. Citizens aged 18 and over were included based on practical accessibility (convenience sample). Informed consent was obtained from participants before the survey began.
The survey was advertised via social media (Instagram, Facebook), local newspapers, magazines and advertising flyers, as well as distributed via the municipal company's senior citizens' advisory councils.
The data collection was completely anonymous. It was not necessary to obtain an ethics approval (correspondence with the Ethics Committee of the University of Würzburg, AZ 20201117 01).

Survey instrument
The entire questionnaire consisted of 71 items (Fleischmann et al. under review), at the end of which there was a section on Internet searches, which formed the basis for the present analysis. The objective level of knowledge of the respondents was recorded in the main part of the questionnaire with 34 questions about the type, purpose and application of precautionary documents. A total score with a maximum of 34 achievable points was created from the number of correct answers.
The first section on Internet search recorded the use of the Internet to search for information about pension documents (“Have you ever searched the Internet for information about pension documents?” with the answer categories “yes” and “no”) as well as the type of information searched (“What information about pension documents have you already searched for on the Internet?”). Six closed answer categories with the most common search options as well as a free text field for further answer alternatives were offered.
This was followed by four items about experiences with searching for information on the Internet, which are based on the German translation of the Information Seeking Experience Scale (Baumann et al. 2020). These related to finding information (“I was able to easily find the information I needed”), frustration (“finding information frustrated me”), quality of information (“I was worried about the quality of the information”) and the comprehensibility of the information Information (“I could easily understand the information found”). This was followed by an item about general satisfaction with the search results. The items were rated on a 4-point Likert scale from “disagree” to “agree”. Due to a programming error, the item about finding information was excluded from the analysis and was not evaluated further.
The evaluation was primarily carried out descriptively using IBM SPSS 28.
Sample description
Figure 1 shows the sample development for the different sections of the survey. The completion rate of the entire questionnaire was 10.1%. There were no missing values for the evaluation for the additional module for searching for information on the Internet or for the experiences made in this context.
The 240 respondents who completed the final section of the survey ranged in age from 19 to 83 years (MAge = 50.3 years, SD = 15.4). The sociodemographic characteristics of the sample are presented in Table 1. In the present study, the level of education was defined by the highest school qualification achieved. The majority of those surveyed have a pension document (142/59.2%). Of the 34 maximum points that could be achieved in the knowledge test about pension documents, the respondents achieved an average of 22 points (SD = 4.4, range 4 to 30).
Results

Searching for information on the Internet
For the majority of those surveyed, the Internet is a potential source of information about pension documents. When asked about the media used to search for information, 155 respondents (64.6%) stated that they would consider searching via free internet research. The websites of official institutions such as ministries come into question for 178 (74.2%), particularly often for people with a high level of education (65/ 91.5% of all people with a high level of education). Non-digital information offerings such as information brochures/guides from bookstores or magazine articles were mentioned less frequently as potential sources of information (106/44.2% and 66/27.5%). While young adults between the ages of 18 and 34 showed clearer preferences for digital offers (only 1/1.9% are not considering digital offers), older adults over 65 years of age chose this less frequently (11/23.4%). No significant gender differences could be found.
When asked about their actual previous search behavior, 160 (66.7%) stated that they had already searched for information about pension documents on the Internet. The proportion of people who stated that they use the Internet to search for information increases with age (rpb = .310, p < .001). While there were only 24 people in the 18 to 34 year old age group (44.4% in this age group), 40 people (85.1 %) reported this among those over 65 years of age (35 to 49 years: 32/62, 7%; 50 to 64 years: 64/72.7%). No association was found between education level, gender or knowledge test scores and Internet use to search for information. Most frequently, respondents searched for templates for pension documents (138/86.3%) and general information (124/77.5%). Around 1/3 of those surveyed (62/38.8%) were looking for information or assistance in creating pension documents. The verification of specific statements (22/13.8%), the search for advisory bodies and people (17/10.6%) or assistance with specific application examples (19/11.9%) were less of a focus in the search.
Experiences in searching for information
The experiences of the 160 respondents who had already searched for information about pension documents on the Internet were very different. Table 2 shows the proportion of agreement for the items frustration with the search, concern about the quality of the information, understandability of the information and satisfaction with the search for the entire sample and relevant subgroups.
The older adult group tended to report less frustration, less concern about the quality of information, better comprehensibility, and greater overall satisfaction with information seeking. The frustration experienced had a significantly weak negative correlation with the age of the respondents (p = -.191, p = .016). There are also differences between different age groups in terms of understanding the information found (Kruskal-Wallis test: Chi-square(3) = .916, p = .001). The 35 to 49-year-old adults were significantly less likely to say that they easily understood the information they found on pension documents than the 18 to 34-year-olds (z = 3.728, p = .001, effect size r = .498), 50 to 64-year-olds (z = -3.051, p = .014, effect size
r = .311) and those over 65 years old (z = -2.851, p = .026, effect size r = .336). No significant differences were found for gender or educational level.
Looking at the results of the knowledge test, it is noticeable that they are related to the perceived experience of searching for information on the Internet. As knowledge scores increased, people reported less frustration (p = -.258, p = .001), less concern about the quality of the information (p = -.263, p < .001), better comprehensibility (p = .334, p < .001) and greater general satisfaction with information search (p = .320, p < .001). However, these results do not allow any conclusions to be drawn about the causal relationship between knowledge and experience with searching for information on the Internet.
discussion
The Internet is an important source of information about advance care documents such as living wills and health care power of attorney. Consistent with other studies (Schaeffer et al. 2021; Neuert et al. 2017), a majority of respondents stated that they use the Internet when looking for information or consider it as a source; Searching on the websites of official institutions (such as ministries) is preferred. What was striking in the present survey was the high number of people over 65 years of age who use online offers (around 85%). In comparable representative studies in the field of health information, the values for the older age group of 40.0% (Schaeffer et al. 2021) and 31.8% (Neuert et al. 2017) were significantly below the values observed here. One possible explanation for this difference between those over 65 and the younger age groups in the present study is the topic of precautionary planning, which becomes more relevant with advancing age, which is also reflected in the increased occurrence of precautionary documents in older age groups (IfD Allensach 2014; Fleischmann et al. in review).
If you look at the reported search experiences (frustration, concern about quality, comprehensibility, general satisfaction) a very heterogeneous picture emerges. The respondents were roughly divided into people who reported positive experiences and few difficulties, and people who said the opposite. Unexpectedly, the over 65 age group often reported positive experiences when searching for information on the Internet. This raises the question of whether older people actually have a high level of competence in dealing with information on the Internet or, on the contrary, are too uncritical and overestimating themselves when searching for information on the Internet. Previous studies suggest that older people have greater difficulty dealing with digital information (Schaeffer et al. 2021). Whether and how perceived and actual search success are related was mostly left open in previous studies. The results of the present study indicate that objective and subjective search success are close to each other. People with more knowledge about advance care documents reported less frustration, less concern about the quality of information, better understanding of the information, and greater overall satisfaction with the search. This suggests that people can actually realistically assess their search success, provided digital information is used as a central source of information. However, due to the study design, no causal relationship can be proven.
The present study makes it clear that a considerable proportion of the older population also accepts information offers on the Internet and can also be reached via these channels. Given the varying quality of the digitally available information (Stuart 2017) and the low level of digital health literacy in older age groups, the question arises as to how digital offerings can be integrated into care as profitably as possible. On the one hand, the focus must be on the digital offerings themselves and on the ability of those searching to correctly evaluate the information found online in order to avoid additional strain on the supply system caused by poorly or misinformed people. Further research to clarify the connection between subjective health literacy, which has already been measured many times, and objectively measurable competencies appears necessary.
limitations
Due to regional recruitment, the survey is not representative of the general German population. A wide age range was reached, although a large proportion of those surveyed, and therefore proportionately more than in the general population, had an academic education. The call for participation using the keyword pension documents may also have resulted in a selection of people with above-average information about the topic and the online survey may have resulted in the participation of particularly digitally savvy people. In fact, the proportion of people who already have a pension document in the sample is higher than would be expected in the general population. Studies with a representative sample are necessary to confirm the results. It must also be noted that due to the study design, only self-assessments from the respondents were collected and biases in response behavior cannot be ruled out. The present study does not allow any conclusions to be drawn about causal relationships. <<