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Item Open Access The burden of cancer in Austria(Wolters Kluwer, 1999-02) Vutuc, C; Waldhoer, T; Haidinger, G; Ahmad, F; Micksche, MThe aim of this study was to assess the overall progress against cancer in Austria by analysing changes in age-adjusted mortality rates from 1970 to 1996. For the years 1970 to 1996, age-adjusted rates for all malignant neoplasms and for selected sites were calculated for men and women, according to year, age and sex. The number of cancer deaths were obtained from the Austrian Central Statistical Office--age-adjusted mortality rates of all malignant neoplasms decreased in men between 1971 and 1996 by 13% (from 289.1 to 251.4 deaths per 100,000), and in women between 1970 and 1996 by 19.1% (from 276.6 to 223.7 deaths per 100,000). Among older people (> or = 55 years) the mortality decreased by 13% in men and by 17% in women; among younger people (< 55 years) by 12% and 30%, respectively. The decrease in total cancer mortality is promoted by three tumour sites (the leading causes of cancer deaths in 1970). In both sexes, the decrease of stomach cancer mortality had the major impact, followed by colorectal cancer in women and by lung cancer in men. The observed changes in mortality are primarily related to changing incidence and early detection, rather than improvements in treatment. Unfortunately, there is evidence that prevention is losing ground in Austria. The implementation of the well-established knowledge of cancer prevention and the strengthening of preventative research is urgently needed.Item Open Access Women physicians and stress(Mary Ann Liebert, 2000-03) Stewart, Donna Eileen; Ahmad, F; Cheung, Angela M.; Bergman, B; Dell, DLMost women physicians enjoy better than average physical health and lead satisfying and productive lives. However, higher than average rates of depression, anxiety, marital problems, and substance abuse have been reported by some, but not all, authors. This quantitative survey of 196 women physicians and qualitative focus groups with 48 other women physicians was conducted to determine perceptions of their health, stress, satisfaction, knowledge, and abuse rates in medical practice. Eight specialties plus family practice physicians participated. The average age was 44.1 years (SD 8.8, range 23–77). Seventy-four percent of women physicians were married, with children. Specialists and family physicians were similar in all demographic characteristics except that family physicians were more significantly likely to be divorced, separated, or widowed (p ≤ 0.01). Specialists perceived their personal physical health to be better than that of family doctors (p ≤ 0.05), and family physicians rated their medical knowledge better than that of specialists (p ≤ 0.0001). Women physicians over age 50 or with children over age 19 reported the best mental health (p ≤ 0.0001 and 0.003, respectively). Overall, 49% of women physicians reported usually having high levels of stress, 44% felt mentally tired, and 17% took antidepressant drugs. Seventy-three percent reported verbal abuse at work (71% in the last year), and 33% reported physical assault at work (11% in the last year). Focus groups identified three major sources of stress: high expectations, multiple roles, and work environment. These results are discussed and compared with the literature. Both personal and systemic strategies are required to solve the problems identified. Women physicians can facilitate the adoption of some of these strategies by sharing information about successes, challenges, and solutions.Item Open Access Primary prevention of violence against women(Elsevier, 2000-11) Hyman, I; Guruge, S; Stewart, Donna Eileen; Ahmad, FThe best mechanisms to prevent violence against women were reviewed in a critical appraisal conducted by the University Health Network Women’s Health Program. Several promising primary interventions were identified. These included: educational and policy-related interventions to change social norms, early identification of abuse by health and other professionals, programs and strategies to empower women, safety and supportive resources for victims of abuse, and improved laws and access to the criminal justice system. The policy recommendations emerging from this analysis are presented.Item Open Access Knowledge about human papillomavirus among adolescents(Wolters Kluwer, 2000-11) Dell, DL; Chen, H; Ahmad, F; Stewart, Donna EileenObjective: To assess knowledge of human papillomavirus (HPV) among high school–aged adolescents. Methods: We administered written surveys to 523 innercity high school students in Toronto, Canada, that asked about HPV, other sexually transmitted diseases (STDs), and Papanicolaou testing. We also asked them to report doctor or clinic visits and whether they received sexual health information at those visits. The predictor variables used in analysis were gender and sexual experience. Results: Eighty-seven percent of our population [95% confidence interval (CI) 84%, 89%) had not heard of HPV. Although adolescent women were more knowledgeable about Papanicolaou testing than adolescent men, only 39% of sexually experienced adolescent women knew who should get a Papanicolaou test. Sexually experienced and inexperienced adolescents failed to identify correctly their STD risk. Both genders showed greater knowledge about human immunodeficiency virus (HIV) than other diseases. Among adolescent women, 85% had visited a doctor or clinic within the past year, but only 29% had talked about sexual health. Conclusion: Knowledge of HPV infection and cervical cancer screening was low in this urban adolescent population. Improved efforts are needed for prevention of HPV infection and HPV-related cervical changes. Programs modeled after HIV-education programs might be effective. Doctors’ offices and clinics providing health care to adolescents should take greater responsibility in sexual health education.Item Open Access Rural physicians’ perspectives on cervical and breast cancer screening: A gender-based analysis(Mary Ann Liebert, 2001-03) Ahmad, F; Stewart, Donna Eileen; Cameron, Jill; Hyman, ISeveral studies highlight the role of physicians in determining cervical and breast cancer screening rates, and some urban studies report higher screening rates by female physicians. Rural women in North America remain underscreened for breast and cervical cancers. This survey was conducted to determine if there were significant gender differences in practices and perceptions of barriers to breast and cervical cancer screening among rural family physicians in Ontario, Canada. One hundred ninety-one family physicians (response rate 53.1%) who practiced in rural areas, small towns, or small cities completed a mail questionnaire. The physicians’ mean age was 44.4 years (SD 9.9), and mean number of years in practice was 16.6 years (SD 10.3). Over 90% of physicians reported that they were very likely to conduct a Pap test and clinical breast examination (CBE) during a periodic health examination, and they had high levels of confidence and comfort in performing these procedures. Male (68%) and female (32%) physicians were similar in their likelihood to conduct screening, levels of confidence and comfort, and knowledge of breast and cervical cancer screening guidelines. However, the self-reported screening rates for Pap tests and CBE performed during last year were higher for female than male physicians (p < 0.01). Male physicians reported they were asked more frequently by patients for a referral to another physician to perform Pap tests and CBE (p < 0.001). Also, male physicians perceived patients’ embarrassment as a stronger barrier to performing Pap tests (p < 0.05) and CBE (p < 0.01) than female physicians. No gender differences were observed in screening rates or related barriers to mammography referrals. These findings suggest that physicians’ gender plays a role in sex-sensitive examination, such as Pap tests and CBE. There is a need to facilitate physician-patient interactions for sex-sensitive cancer screening examinations by health education initiatives targeting male physicians and women themselves. The feasibility of providing sex-sensitive cancer screening examinations by a same-sex health provider should also be explored.Item Open Access Preferences for gender of family physician among Canadian European-descent and South-Asian immigrant women(Oxford University Press, 2002-04) Ahmad, F; Gupta, H; Rawlins, J; Stewart, Donna EileenObjective. The aim of this study was to investigate expressed preferences for family physician (FP) gender among Canadian European-descent (CED) and Canadian South-Asian (CSA) immigrant women. Method. An ‘on-site’ survey was conducted in community-based institutions in Toronto in order to determine preferences for the gender of FP under various health care scenarios: overall health care; gender-sensitive examinations; emotional problems; general ailments; and life-threatening conditions. Results. Ninety-four women responded to this survey (CED = 50, CSA = 44), response rate 77.3%. For all health care scenarios, CED and CSA women similarly expressed either a preference for a female FP or no preference. More than two-thirds of women preferred a female FP for gynaecological examinations (CED, 72.9%; CSA, 83.7%) or examinations with private body part exposure (CED, 72%; CSA, 81.8%). For ‘emotional problems', half of the women preferred a female FP and the other half had no preference. A similar pattern was observed for ‘overall health care', with some shift to female physician preference among CSA women (60.5%) compared with CED women (53.2%). For the ‘overall health care' scenario, CED and CSA women who preferred a female FP had a higher frequency of seeing female physicians within the last 5 years (CED, P ≤ 0.01; CSA, P ≤ 0.05), and attributed ‘positive' social skills more to female physicians (CED, P ≤ 0.01; CSA, P ≤ 0.01) compared with women with no preference for the gender of the FP. Yet, CED women with a female FP preference were more likely to have a concurrent female FP (P ≤ 0.01), and to rate past experiences with female physicians as high (P ≤ 0.01) and with male physicians as low (P ≤ 0.05) compared with CED women with no preference. In the CSA group, women with a preference for a female FP were more likely to be unemployed (P ≤ 0.01) and have low social support (P ≤ 0.01). Conclusions. Despite similar physician gender preference patterns, factors associated with these preferences show some differences between CED and CSA women.Item Open Access Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model(Elsevier, 2002-05) Austin, LT; Ahmad, F; McNally, MJ; Stewart, Donna EileenThe aim of this study was to review published studies that examined factors influencing breast and cervical cancer screening behavior in Hispanic women, using the Health Belief Model (HBM). MEDLINE and PsycINFO databases and manual search were used to identify articles. Cancer screening barriers common among Hispanic women include fear of cancer, fatalistic views on cancer, linguistic barriers, and culturally based embarrassment. In addition, Hispanic women commonly feel less susceptible to cancer, which is an important reason for their lack of screening. Positive cues to undergo screening include physician recommendation, community outreach programs with the use of Hispanic lay health leaders, Spanish print material, and use of culturally specific media. Critical review of the literature using the theoretical framework of the Health Belief Model identified several culturally specific factors influencing cancer screening uptake and compliance among Hispanic women. Future interventions need to be culturally sensitive and competent.Item Open Access Women's hysterectomy experiences and decision-making(Taylor & Francis, 2003) USKUL, AYSE K.; Ahmad, F; Leyland, NA; Stewart, Donna EileenThe goal of the study was to examine women's experiences with gynaecologic symptoms and how they decided to undergo hysterectomy. For this purpose, twenty-nine women were interviewed in hospital within three days of undergoing hysterectomy. The interviews elicited information about the nature of the problem that caused the women to seek medical help, actions taken to solve their problem, their relationship with their gynaecologist, information seeking patterns and decision-making about hysterectomy. Although findings revealed that the symptoms women suffered had a negative impact on their lives, most women delayed seeking medical help and attributed their symptoms to factors other than a physical problem in their reproductive system. Most of the participants' information about the symptoms and possible treatments came from their consulting other women with similar problems. The women reported that their gynaecologist did not initiate a comprehensive discussion about other treatments and their advantages and dis-advantages. Only women who had informed themselves about other treatments actively discussed alternatives to hysterectomy with their physicians. The women's decision-making process about undergoing hysterectomy was difficult and depended primarily on the women's illness experiences, age, wish for future children, information they gathered from their gynaecologist and from other women. The findings are discussed in relation to the importance of information provision by gynaecologists and its effects on women's decision-making about hysterectomy.Item Open Access Physician health, stress and gender at a university hospital(Wolters Kluwer, 2003-02) Bergman, B; Ahmad, F; Stewart, Donna EileenObjective: To determine personal and work related factors contributing to physician health and stress in men and women physicians in a university hospital. Method: Mail survey of 161 hospital-based Canadian academic physicians (51 women, 110 men). Results: Women compared to men, physicians were younger (M= 43 years, S.D. = 7.4 vs. M= 48 years, S.D. = 8.64; P=.001) and fewer had spouses (76% vs. 90%; P= .01) and children (76% vs. 91%; P=.02). A five-item scale measured somatic symptoms, the dependent variable. Among physicians of both gender, the somatic symptoms scale was significantly correlated with satisfaction with amount of time spent working and scales of mental health (five items), work satisfaction (five items), workload (five items), healthy lifestyle (five items), coping abilities (three items) and support-in-stress (two items). On stepwise regression analysis, for women physicians, 70% of the variance in somatic symptoms was explained by support from colleagues when stressed, and workload. For men, 42% of the variance was explained by healthy lifestyle, mental health, support from colleagues when stressed, and workload. Regardless of gender, the majority of physicians reported an excessive workload but the sources of support when stressed varied by gender. Conclusion: Different strategies are needed for women and men physicians to reduce their stress levels.Item Open Access Physician–patient interaction: a gynecology clinic in Turkey(Elsevier, 2003-07) USKUL, AYSE K.; Ahmad, FEvidence for gender differences in physicians' communication with their patients comes primarily from Western countries. Little is known about whether these gender differences would also be observed in Turkey, where there are explicit rules about male-female conduct. The purpose of this study was to observe male and female gynecologists' communication with their patients in a gynecology clinic at a state hospital in Istanbul, Turkey. Four male and three female gynecologists were observed in their interaction with 70 patients over 10 days. The observations were conducted during both the history taking and the actual examination sessions by a woman researcher. The results reported in this paper are based on the extensive field notes taken during the observations. Important differences were revealed in interactions between male vs female gynecologists and their patients. Namely, interactions differed in terms of conversation initiation, communication style, use of technical and colloquial language, frequency of eye contact, patience, and provision of information. Communication characteristics specific to interactions between male gynecologists and their patients included a 'blaming the victim' approach, differential treatment of patients, and underestimation of patients' abilities. Environmental factors that affected physicians' interaction with their patients are reported in conjunction with physicians' use of these external factors to explain the problems they experienced in physician-patient interaction. The discussion focuses on alternative explanations for and future research implications of the observed differences between male and female gynecologists in this setting.Item Open Access Voices of South Asian women: immigration and mental health(Taylor & Francis, 2004) Ahmad, F; Shik, A; Vanza, R; Cheung, Angela M.; George, U; Stewart, Donna EileenPurpose: This qualitative research aimed to elicit experiences and beliefs of recent South Asian immigrant women about their major health concerns after immigration. Methods: Four focus groups were conducted with 24 Hindi-speaking women who had lived less than five years in Canada. The audiotaped data were transcribed, translated, and analyzed by identification of themes and subcategories. Results: Mental health (MH) emerged as an overarching health concern with three major themes, i.e., appraisal of the mental burden (extent and general susceptibility), stress-inducing factors, and coping strategies. Many participants agreed that MH did not become a concern to them until after immigration. Women discussed their compromised MH using verbal and symptomatic expressions. The stress-inducing factors identified by participants included loss of social support, economic uncertainties, downward social mobility, mechanistic lifestyle, barriers in accessing health services, and climatic and food changes. Women's major coping strategies included increased efforts to socialize, use of preventative health practices and self-awareness. Conclusion: Although participant women discussed a number of ways to deal with post-immigration stressors, the women's perceived compromised mental health reflects the inadequacy of their coping strategies and the available resources. Despite access to healthcare providers, women failed to identify healthcare encounters as opportunities to seek help and discuss their mental health concerns. Health and social care programs need to actively address the compromised mental health perceived by the studied group.Item Open Access Popular health promotion strategies among Chinese and East Indian immigrant women(Taylor & Francis, 2004) Ahmad, F; Shik, A; Vanza, R; Cheung, Angela M.; George, U; Stewart, Donna EileenPurpose: To advance understanding about the popular health promotion strategies and factors associated with the successful transfer and uptake of health messages among Chinese and Indian immigrant women. Methods: Eight focus groups were conducted with 46 immigrant women, 22 from Mainland China and 24 from India, who had lived less than 5 years in Canada. Audiotaped data were transcribed, translated and analyzed by identification of themes and subcategories within and between groups. Results: In both ethnic groups, discussions on promoting health messages had five major themes, i.e., sources, barriers, facilitators, credibility and ways to improve access along with group specific sub-themes. Despite identification of several diverse sources of health information in the adopted country, Indian and Chinese immigrant women perceived most strategies as not very effective. The reasons of perceived ineffectiveness were barriers to accessing and comprehending the health messages; and limited prior exposure to institution based or formal health promotion initiatives. These women were more familiar with informal means of obtaining health information such as social networks, mass media and written materials in their mother tongue. Conclusion: Existing health communication and health promotion models need to be re-orientated from a one-way information flow to a two-way dialogue model to bridge the gap between program efficacy and effectiveness to reach underserved immigrant women. An “outside the box” approach of non-institutional informal health promotion strategies needs to be tested for the studied groups.Item Open Access Patriarchal beliefs and perceptions of abuse among South Asian immigrant women(SAGE, 2004-03) Ahmad, F; Riaz, S; Barata, P; Stewart, Donna EileenThis study investigates the relationship between South Asian immigrant women’s patriarchal beliefs and their perceptions of spousal abuse. Twenty-minute telephone surveys were conducted with 47 women. The survey collected information about demographic characteristics, patriarchal beliefs, ethnic identity, and abuse status. Participants were read a vignette that depicted an abusive situation and were asked whether they felt that the woman in the vignette was a victim of spousal abuse. As hypothesized, higher agreement with patriarchal social norms predicted a decreased likelihood of identifying the woman in the vignette as a victim of spousal abuse. This finding is discussed in terms of its application to violence against women educational programs in the South Asian immigrant community.Item Open Access Predictors of clinical breast examination among South Asian immigrant women(Journal of Immigrant Health, 2004-07) Ahmad, F; Stewart, Donna EileenTo determine predictors of clinical breast examination (CBE) among South Asian immigrant women residing in Toronto, Canada. A cross-sectional self-administered survey with women patients visiting family physician group practices. Fifty-four women participated in the study (response rate 77%). Twenty women (38.5%) “ever had” CBE. Compared to women who never had CBE, women who had CBE were statistically older, had lived more years in Canada, had better knowledge of breast cancer, had lower perceived barriers to CBE, and were more likely to have ever had a periodic health exam. No significant differences were found between the two groups for education, employment, English language abilities, perceived health, and perceived benefits of CBE. A direct logistic regression with five predictor variables, significant at a univariate level, was statistically reliable, X2 (5, n=51) = 34.7, p < 0.001 and explained 67% of the variance in the CBE status. Age and perceived barriers to CBE remained significant over and above other predictor variables. The odds of 'ever had' CBE increased with age and decreased with more perceived barriers. The study highlights the need for education interventions on breast cancer and screening among SA recent immigrant women.Item Open Access Eating Disorders(BioMed Central, 2004-08-25) Gucciardi, Enza; Celasun, N; Ahmad, F; Stewart, Donna EileenHealth Issue: Eating disorders are an increasing public health problem among young women. Anorexia and bulimia may give rise to serious physical conditions such as hypothermia, hypotension, electrolyte imbalance, endocrine disorders, and kidney failure. Key Issues: Eating disorders are primarily a problem among women. In Ontario in 1995, over 90% of reported hospitalized cases of anorexia and bulimia were women. In addition to eating disorders, preoccupation with weight, body image and self-concept disturbances, are more prevalent among women than men. Women with eating disorders are also at risk for long-term psychological and social problems, including depression, anxiety, substance abuse and suicide. For instance, in 2000, the prevalence of depression among women who were hospitalized with a diagnosis of anorexia (11.5%) or bulimia (15.4 %) was more than twice the rate of depression (5.7 %) among the general population of Canadian women. The highest incidence of depression was found in women aged 25 to 39 years for both anorexia and bulimia. Data Gaps and Recommendations: Hospitalization data are the most recent and accessible information available. However, this data captures only the more severe cases. It does not include the individuals with eating disorders who may visit clinics or family doctors, or use hospital outpatient services or no services at all. Currently, there is no process for collecting this information systematically across Canada; consequently, the number of cases obtained from hospitalization data is underestimated. Other limitations noted during the literature review include the overuse of clinical samples, lack of longitudinal data, appropriate comparison groups, large samples, and ethnic group analysis.Item Open Access A tailored intervention to promote breast cancer screening among South Asian immigrant women(Social Science and Medicine, 2005-02) Ahmad, F; Cameron, Jill; Stewart, Donna EileenThis study developed and evaluated a socioculturally tailored intervention to improve knowledge, beliefs and clinical breast examination (CBE) among South Asian (SA) immigrant women. The intervention comprised a series of socioculturally tailored breast-health articles published in Urdu and Hindi community newspapers. A pre- and post-intervention design evaluated the impact of the mailed articles among 74 participants. The mean age of participants was 37 years (SD 9.7) and they had lived 6 years (SD 6.6) in Canada. After the intervention, there was a significant increase in self-reporting 'ever had' routine physical checkup (46.4-70.8%; p < 0.01) and CBE (33.3-59.7%; p < 0.001). Also, the total summed scores of accurate answers to 12 knowledge items increased (3.3-7.0; p < 0.001). For constructs of health belief model, participants rated their level of agreement for a number of items on a scale of 1-4 (disagree to agree). After the intervention the following decreased: misperception of low susceptibility to breast cancer among SA immigrant women (3.0-2.4; p < 0.001); misperception of short survival after diagnosis (2.7-1.8; p < 0.001); and perceived barriers to CBE (2.5-2.1; p < 0.001). Self-efficacy to have CBE increased (3.1-3.6; p < 0.001). The change scores of five predictor variables were entered in a direct logistic regression to predict the uptake of CBE among participants who never had it prior to the intervention. The model, as a set, was statistically reliable [x2(5, n = 48) = 14.2 , p < 0.01] and explained 35% of variance in the outcome; perceived barriers remained an independently significant predictor. The results support the effectiveness of written socioculturally tailored language-specific health education materials in promoting breast cancer screening within the targeted population. Future research should test the intervention in other vulnerable populations.Item Open Access Spousal-abuse among Canadian immigrant women(Springer, 2005-10) Ahmad, F; Ali, M; Stewart, Donna EileenThe study aimed to investigate the rates of self-reported physical and emotional spousal abuse among recent Canadian-immigrant (CI) women compared to Canadian-born (CB) women. The study conducted secondary data analyses on the General Social Survey, 1999. A sample of CB (n = 3548) and CI (n = 313) women was drawn that included women 25 to 49 years of age who were currently married or in a common-law relationship. Person weights and bootstrapping estimates were used to estimate the 95% confidence intervals. The proportion of emotional spousal abuse was higher in CI (14.7%, 95% CI: 10.7–18.8%) compared to CB women (8.7%, 95% CI: 7.8–9.6%). However, the proportion of physical spousal abuse was not statistically different between two groups. Possible explanations are discussed setting direction for future research and services for immigrant women.Item Open Access A Politics of Hope in the Narratives of People with Dementia(2005-10-05) O'Brien, Jennifer; Barton, LenThe social model of disability challenges the notion of disability as a personal tragedy and reason for despair. Seven autobiographies written by people with dementia are analysed within the social model of disability for evidence of hope and hopelessness. Categories of hope and hopelessness delineated in this research include hope/despair for a cure, hope/despair for social inclusion and involvement, hope/despair related to voice (including being heard and taken seriously), hope/despair related to supports, hope/despair related to personal development, control, and survival, and other evidence of hope and hopelessness. An examination of how political hope expressed within these narratives contributes to the collective hope of people with dementia is included, as well as an exploration of implications for the larger disability rights movement.Item Open Access Cross-cultural perspectives on research participation and informed consent(Elsevier, 2006-01) Barata, PC; Gucciardi, Enza; Ahmad, F; Stewart, Donna EileenThis study examined Portuguese Canadian and Caribbean Canadian immigrants' perceptions of health research and informed consent procedures. Six focus groups (three in each cultural group) involving 42 participants and two individual interviews were conducted. The focus groups began with a general question about health research. This was followed by three short role-plays between the moderator and the assistant. The role-plays involved a fictional health research study in which a patient is approached for recruitment, is read a consent form, and is asked to sign. The role-plays stopped at key moments at which time focus group participants were asked questions about their understanding and their perceptions. Focus group transcripts were coded in QSR NUDIST software using open coding and then compared across cultural groups. Six overriding themes emerged: two were common in both the Portuguese and Caribbean transcripts, one emphasized the importance of trust and mistrust, and the other highlighted the need and desire for more information about health research. However, these themes were expressed somewhat differently in the two groups. In addition, there were four overriding themes that were specific to only one cultural group. In the Portuguese groups, there was an overwhelming positive regard for the research process and an emphasis on verbal as opposed to written information. The Caribbean participants qualified their participation in research studies and repeatedly raised images of invasive research.Item Open Access Are physicians ready for patients with Internet-based health information?(Journal of Medical Internet Research, 2006-09-29) Ahmad, F; Hudak, PL; Bercovitz, K; Hollenberg, E; Levinson, WBackground: An increasing number of patients bring Internet-based health information to medical consultations. However, little is known about how physicians experience, manage, and view these patients. Objective: This study aimed to advance the understanding of the effects of incorporating Internet-based health information into routine medical consultations from physicians’ perspectives, using a qualitative approach. Methods: Six focus groups were conducted with 48 family physicians practising in Toronto. The data were analyzed using qualitative methods of content analysis and constant comparison, derived from grounded theory approach. Results: Three overarching themes were identified: (1) perceived reactions of patients, (2) physician burden, and (3) physician interpretation and contextualization of information. Physicians in our study generally perceived Internet-based health information as problematic when introduced by patients during medical consultations. They believed that Internet information often generated patient misinformation, leading to confusion, distress, or an inclination towards detrimental self-diagnosis and/or self-treatment. Physicians felt these influences added a new interpretive role to their clinical responsibilities. Although most of the physicians felt obliged to carry out this new responsibility, the additional role was often unwelcome. Despite identifying various reactions of patients to Internet-based health information, physicians in our study were unprepared to handle these patients. Conclusion: Effective initiatives at the level of the health care system are needed. The potential of Internet-based health information to lead to better physician-patient communication and patient outcomes could be facilitated by promoting physician acknowledgment of increasing use of the Internet among patients and by developing patient management guidelines and incentives for physicians.