Material and Methods; strengths and limitations
The general rate of response (63%) for the 'Student Health Survey 2004' was good compared with recent studies of the Finnish student population with response rates ranging from 44% to 48% [29, 30]. The response rate among female students in the 'Student Health Survey 2004' was high (74%) and 2 001 out of 2 021 (99%) of female respondents answered target questions concerning the web-based health advice service, chronic conditions, and health status. The study results can thus be considered representative of the female student population at universities in Finland.
The response rate among male students in the 'Student Health Survey 2004' remained just under 50% (49%). The results concerning male students should thus be generalized cautiously. Low response rates in health surveys are not unusually observed in young male populations. In 2004 the response rate for a Finnish national health survey was lowest (54%) among young men aged 15 – 24 in an evaluation by sex and age group .
The main limitation of our study is insufficiency of result generalization at the population level. University students are not representative of the whole population. However, it is possible to regard these university students as 'pilot population' representing the young adult population of the information society.
The study design and statistical methods (cross-tabulation and χ2 test) chosen for our study enable us to characterize the users of web-based health advice service in general. However, statistical methods used in our study are insufficient for indicating the dependence of variables on one another, or for showing the order of importance of variables. In addition, no corrections for multiplicity were applied as this is an explorative study. As the number of statistical tests is quite large in our study, p-values close to the significance limit of 0.05 should be interpreted with caution.
Our method for estimating one's own health status is a widely adopted method for the holistic evaluation of health and wellbeing . It gives information about a survey respondent's health status in relation to his reference group . Health experienced by individuals has been shown to be an independent variable associated with mortality and morbidity that is also among young people .
Surveys questions chosen for our study concerning chronic conditions have been used in a similar form in recent surveys on the national population level and among the student population [31, 35, 36]. With regard to data on chronic conditions and medical diagnosis, a survey based on data collection from patient records could have given more accurate data.
The percentage (12%) of university students who reported use of the web-based health advice service was not unexpected – it was remarkably lower than the percentage (75%) of students reporting face-to-face contact with the FSHS or the percentage of students (49%) reporting that they had visited the FSHS homepage . However, there are no earlier study results that could be compared with our results to back up this view. Even if medical-based consultation services are popular they have still not been widely used as a study focus .
Comparison with Prior Work
Mental health problems are increasing in western countries in general, as well as among Finnish university students [28, 37, 38]. Finnish national registers of medical consumption show a remarkable increase of anti-depressive medicine consumption during the last 4 years .
Mental health problems are of high clinical importance in adolescent medicine and school and student health care settings. Three out of four mental health problems among adults had their onset already before age of 24 . Psychological distress has been shown to associate with frequent use of health care services, but only a minority of distressed young people has been seeking help by mental care professionals .
Thus, the association between the use of the web-based health service and psychiatric conditions is result of high clinical importance in this study. This result is supported by the results of earlier studies concerning the association between chronic conditions and the active general use of the Internet for health purposes [3, 21, 23, 26]. It also states that the Internet as method and written form of expression is suitable for sensitive, stigmatized, or disquieting health issues [18, 25, 42]. An anonymous way of asking questions on delicate themes can provide the opportunity to test the capability of health service providers regarding sensitive issues. These aspects can be emphasized when it comes to mental health problems and can contribute to the patients' general motivation and courage to seek help in health care.
The prevalence of allergic disorders has increased during the last decade . The prevalence of allergic rhinitis in the university student population has been 17–20% in recent studies [28, 36, 43]. Students with allergic rhinitis perceived their health as being worse than that of the control group; they had more symptoms and medication, and also used health services more frequently . Finnish national registers of medicine consumption show an increase in systemic antihistamine consumption over recent years .
In our study male users of the web-based health advice service had been diagnosed more frequently with allergic rhinitis and conjunctivitis compared with male students not reporting use of the web-based health service. This finding can be explained as young a man's way of handling a chronic health problem using an eHealth service with easy access. The service can be a way of avoiding congested appointments, or phone services. Among male students the most requested eHealth services were appointment scheduling and prescription renewals . Men who used anonymous Internet consultation stated that expressed interest in the explanation of symptoms was the main reason for using the service . An association between a recently received chronic diagnosis and subscribing to an electronic messaging service was discovered in a recent study, where most of the patients were well-educated middle-aged men . Our study results concerning the association of allergic disorders and the use of web-based health advice service supported by recent corresponding study findings indicate that focused eHealth services could provide support for managing chronic health problems [18, 45].
Our study results concerning the association between cardiovascular diseases, and kidney and urinary tract disorders and the use of the web-based health advice service among women have only limited clinical value. The number of women suffering from these conditions was quite low.
The association between self-reported lower health status and use of the Internet for health problems is not supported by our results – self reported health status did not show any association with the use of the web-based health advice service among Finnish university students [3, 22, 46]. Our results can be explained by the primary recruitment of our study population; they are all young and well-educated and the incidence rates of chronic conditions, with multiple loading or daily-life limiting symptoms are low. In addition the use of a health service with easy access and low threshold by highly educated and relatively healthy young women can be explained by a general interest in and awareness of health issues. As far as young adults are concerned, web-based services are perhaps best suited to topics that are important in terms of health education regardless of the user's self-evaluated health status or diagnosed chronic illnesses. Typical topics of this type would include e.g. family planning.