Understanding the sustained use of online health communities from a self-determination perspective

What influences user participation in an online health community? The stimulus-organism-response model perspective

Purpose

The purpose of this paper is to understand the effect of platform characteristics (i.e. media richness and interactivity) on individual perception (i.e. outcome expectations) and consequent behavioral response (i.e. user participation in online health communities (OHCs)) based on the stimulus-organism-response (S-O-R) model.

Design/methodology/approach

This study developed a research model to test the proposed hypotheses, and the proposed model was tested using partial least squares structural equation modeling (PLS-SEM) for which data were collected from 321 users with OHC experience using an online survey.

Findings

The empirical results show the following: (1) the three dimensions of media richness significantly affect the three outcome expectations, except that richness of expression has no significant effect on the outcome expectation of health self-management competence. (2) Human-to-human interaction significantly affects the three outcome expectations. Moreover, compared with human-to-human interaction, human-to-system interaction has a stronger impact on the outcome expectation of health self-management competence. (3) The three outcome expectations have a significant influence on user participation in OHCs.

Originality/value

This study extends the understanding about how platform characteristics (i.e. media richness and interactivity) motivate user participation in the context of OHCs. Drawing on the S-O-R model, this study reveals the underlying mechanisms by which media richness and interactivity are associated with outcome expectations and by which outcome expectations is associated with user participation in OHCs. This study enriches the literature on media richness, interactivity, outcome expectations and user participation in OHCs, providing insights for developers and administrators of OHCs.

What Causes Health Information Avoidance Behavior under Normalized COVID-19 Pandemic? A Research from Fuzzy Set Qualitative Comparative Analysis

Affected by the normalization of the COVID-19 pandemic, people's lives are subject to many restrictions, and they are under enormous psychological and physical pressure. In this situation, health information may be a burden and cause of anxiety for people; thus, the refusal of health information occurs frequently. Health-information-avoidance behavior has produced potential impacts and harms on people's lives. Based on more than 120,000 words of textual data obtained from semi-structured interviews, summarizing a case collection of 55 events, this paper explores the factors and how they combine to lead to avoidance of health information. First, the influencing factors are constructed according to the existing research, and then the fuzzy set qualitative comparative analysis (fsQCA) method is used to discover the configuration relationship of health-information-avoidance behavior. The results show that the occurrence of health-information avoidance is not the result of a single factor but the result of a configuration of health-information literacy, negative emotions, perceived information, health-information presentation, cross-platform distribution, and the network information environment. These findings provide inspiration for reducing the adverse consequences of avoiding health information and improving the construction of health-information service systems.

Online community development in the early stages: the life cycle model application to Medical Sciences Stack Exchange

Purpose

This study aims to investigate the nature and evolution of online communities in the early stages of their life cycles. The authors analyze the topics of discussions in an online community to identify issues related to community development. The authors also compare the topics of exemplary questions that founding members believed to be asked with the real questions based on members' information needs.

Design/methodology/approach

The authors use Medical Sciences Stack Exchange, a health Q&A community of Stack Exchange, which requires four stages of development: definition, commitment, private beta and public beta. The authors collect postings of discussions and health questions in the first three stages, perform a content analysis of the postings and analyze the topics of discussions and health questions.

Findings

The authors find that the topics of discussions evolved dynamically with the issues of community governance, role as a medical/health community, members and roles, content management, quality control and community design. The authors also find that the real questions included more specific and diverse issues than the exemplary questions that founding members expected.

Originality/value

Theoretically, this study tests the community life cycle model in an online community that has explicit phase markers. The findings could shed light on community development and help prioritize issues to solve and decisions to make in its early stages. Additionally, this study focuses on the challenges and concerns in online health community building and solutions generated by collective efforts that could influence health communications in online communities.

Serious information in hedonic social applications: affordances, self-determination and health information adoption in TikTok

Purpose

Hedonic social applications have been increasingly popular among health information consumers. However, it remains unclear what motivates consumers to adopt health information in hedonic applications when they have alternative choices of more formal health information sources. Building on the self-determination theory and the affordances lens, this study aims to investigate how different affordances on hedonic social applications affect consumers' basic psychological needs and further influence their intention to adopt health information on such applications.

Design/methodology/approach

As TikTok demonstrated great potential in disseminating health information, we developed a model that we analyze using the PLS-SEM technique with data collected from a valid research sample of 384 respondents with health information seeking or encountering experience in TikTok.

Findings

The results suggested that health information adoption in hedonic social applications is significantly predicted by the satisfaction of consumers' basic psychological needs, namely autonomy, relatedness and competence. Moreover, the satisfaction of basic psychological needs is positively affected by affordances provided by the hedonic social applications. The hedonic affordances positively influence autonomy satisfaction, while the connective affordances positively affect relatedness satisfaction, and the utilitarian affordances positively support competence satisfaction.

Originality/value

The study indicates that hedonic social applications such as TikTok could be an important channel for consumers to access and adopt health information. The study contributes to the literature by proposing a theoretical model that explains consumers' health information adoption and yields practical implications for designers and service providers of hedonic social applications.

Social Media and Health: Emerging Trends and Future Directions for Research on Young Adults

The ubiquity and affordances of social media have allowed young people to become both active posters and passive recipients of communication related to health. For instance, people may post exercise goals and behaviors on social media, while at the same time, they may be exposed to friends drinking alcohol and/or indulging in unhealthy snacking. This intersection of sociotechnical systems (i.e., social media), and health and wellbeing, has garnered increasing scholarly attention. How to understand and manage the continuous use intention of health-related social media, and then provide a better service platform and create a good service model for the needs of young adults has become an important topic in the research of social media and health-related fields. Based on the SOR theory, this paper constructs a theoretical model of factors affecting the continuous use intention of health-related social media. This paper uses questionnaires and structural equation empirical research methods, relevant software to process and analyze the data, and tests the applicability of the model. The results reveal that emotional support, information support, and service quality can significantly affect pan-family consciousness, pan-family consciousness can significantly affect the continuous use intention of health-related social media. In addition, our results also show that pan-family consciousness plays a mediating role between information support and the continuous use intention of health-related social media, pan-family consciousness plays a mediating role between the service quality and the continuous use intention of health-related social media, and self-efficacy plays a mediating role between pan-family consciousness and the continuous use intention of health-related social media. These findings have important implications for research and practice in the fields of the continuous use intention of health-related social media. We hope to help with the emerging trends and future directions for research on social media and health.

Feeling better on hemodialysis: user-centered design requirements for promoting patient involvement in the prevention of treatment complications

OBJECTIVE

Hemodialysis patients frequently experience dialysis therapy sessions complicated by intradialytic hypotension (IDH), a major patient safety concern. We investigate user-centered design requirements for a theory-informed, peer mentoring-based, informatics intervention to activate patients toward IDH prevention.

METHODS

We conducted observations (156 hours) and interviews (n = 28) with patients in 3 hemodialysis clinics, followed by 9 focus groups (including participatory design activities) with patients (n = 17). Inductive and deductive analyses resulted in themes and design principles linked to constructs from social, cognitive, and self-determination theories.

RESULTS

Hemodialysis patients want an informatics intervention for IDH prevention that collapses distance between patients, peers, and family; harnesses patients' strength of character and resolve in all parts of their life; respects and supports patients' individual needs, preferences, and choices; and links "feeling better on dialysis" to becoming more involved in IDH prevention. Related design principles included designing for: depth of interpersonal connections; positivity; individual choice and initiative; and comprehension of connections and possible actions.

DISCUSSION

Findings advance the design of informatics interventions by presenting design requirements for outpatient safety and addressing key design opportunities for informatics to support patient involvement; these include incorporation of behavior change theories. Results also demonstrate the meaning of design choices for hemodialysis patients in the context of their experiences; this may have applicability to other populations with serious illnesses.

CONCLUSION

The resulting patient-facing informatics intervention will be evaluated in a pragmatic cluster-randomized controlled trial in 28 hemodialysis facilities in 4 US regions.

Mobile Health Apps and Health Management Behaviors: Cost-Benefit Modeling Analysis

BACKGROUND

Rising criticism about the risks associated with the use of mobile health apps necessitates a critical perspective to assess the use of these apps. A cost-benefit approach involving several moderating factors can be used to detect technology effects and individual-level push and pull factors related to health attitudes, lifestyle, and health management behaviors.

OBJECTIVE

We introduce a cost-benefit perspective to examine how health attitudes related to mobile health apps and health situational factors (health crises, health changes, and hospitalization) affect the likelihood of adopting lifestyle and health management behaviors among app users.

METHODS

The analysis is based on individuals' reported use of mobile health apps. The sample included 1495 US adults aged over 18 years who were contacted by landline or cellphone. A total of 50.96% (762/1495) of the participants were women. A set of logistic regression models was used to predict lifestyle and health management behaviors among users considering variations in the extent of use, health attitudes, health situation, and socioeconomic characteristics.

RESULTS

The findings indicate that the proposed models were reasonably adequate. In all, 88.76% (1327/1495) of the cases were correctly classified regarding lifestyle behaviors, but only 71.97% (1076/1495) of the cases were correctly classified regarding health management behaviors. Although a large percentage of individuals changed their attitudes following the use of mobile health apps, only a small proportion adopted health management behaviors. The use of mobile health apps affected up to 67.95% (1016/1495) of the users for consultation and 71.97% (1076/1495) of the users for decision making. The model was effective for 88.76% (1327/1495) of the cases regarding lifestyle behaviors but only 71.97% (1076/1495) regarding health management behaviors. The moderating effect of regular use of mobile health apps significantly affects lifestyle (Wald=61.795; B=2.099; P<.005) but not health management behaviors (Wald=12.532; B=0.513; P=.01). These results collectively indicate that the use of mobile health apps for health management is partially effective.

CONCLUSIONS

The use of mobile health apps is a main route to instigate the process of health empowerment and shape health attitudes. However, an accurate assessment of the effectiveness of mobile health apps necessitates distinguishing between lifestyle and health management behaviors and adopting a cost-benefit approach because individuals facing health concerns, such as a chronic disease, health emergency, health crisis, or health change, consider their affordances and situational effects. These moderators generate a push and pull framework in the decision-making process that balances the costs and benefits of use.

Factors Driving Users’ Engagement in Patient Social Network Systems

Participatory medicine and e-health help to promote health literacy among non-medical professionals. Users of e-health systems actively participate in a patient social network system (PSNS) to share health information and experiences with other users with similar health conditions. Users’ activities provide valuable healthcare resources to develop effective participatory medicine between patients, caregivers, and medical professionals. This study aims to investigate the factors of patients’ engagement in a PSNS by integrating and modifying an existing behavioral model and information system model (i.e., affective events theory (AET) and self-determination theory (SDT)). The AET is used to model the structure, the affective aspects of the driven behavior, and actual affective manifestation. The SDT is used to model interest and its relations with behavior. The data analysis and model testing are based on structural equation modeling, using responses from 428 users. The results indicate that interest and empathy promote users’ engagement in a PSNS. The findings from this study suggest recommendations to further promote users’ participation in a PSNS from the sociotechnical perspective, which include sensitizing and constructive engagement features. Furthermore, the data generated from a user’s participation in a PSNS could contribute to the study of clinical manifestations of disease, especially an emerging disease.

What’s your type? An examination of first-year doctoral student motivation

Educators often ask how to motivate PhD students. Before addressing how to motivate students, we should know what motivates prospective doctoral students. Motivational support has been shown to lead to overall satisfaction with the educational process, better engagement, and persistence. Using the interdisciplinary field of library and information science, this research offers insight on doctoral student motivation through quantitative analysis of results from administration of the Academic Motivation Scale. The instrument measures and classifies motivation from the perspective of self-determination theory. Results suggest PhD students are motivated by several types of intrinsic motivation as well as identified regulation, a type of extrinsic yet autonomous motivation. Findings can be used by program administrators, faculty, and other stakeholders to address the “how” of motivation through better alignment of teaching practices, research activities, and student services based on students’ motivation types.

What motivates Chinese consumers to avoid information about the COVID-19 pandemic?: The perspective of the stimulus-organism-response model

This study investigated consumers' information-avoidance behavior in the context of a public health emergency-the COVID-19 pandemic in China. Guided by the stimulus-organism-response paradigm, it proposes a model for exploring the effects of external stimuli (perceived threat and perceived information overload) related to COVID-19 on consumers' internal states (sadness, anxiety, and cognitive dissonance) and their subsequent behavioral intentions to avoid health information and engage in preventive behaviors. With a survey sample (N = 721), we empirically examined the proposed model and tested the hypotheses. The results indicate that sadness, anxiety, and cognitive dissonance, which were a result of perceived threat and perceived information overload, had heterogeneous effects on information avoidance. Anxiety and cognitive dissonance increased information avoidance intention, while sadness decreased information avoidance intention. Moreover, information avoidance predicted a reluctance on the part of consumers to engage in preventive behaviors during the COVID-19 pandemic. These findings not only contribute to the information behavior literature and extend the concept of information avoidance to a public health emergency context, but also yield practical insights for global pandemic control.

Communication that changes lives: an exploratory research on a Chinese online hypertension community

Purpose

Online health communities (OHCs) are attracting more and more healthy consumers, including patients, their families, caregivers and the general public. This paper aims to explore the themes and characteristics of patient-generated content (PGC) in Chinese OHCs.

Design/methodology/approach

Baidu Tieba for hypertension was selected as the research site. Online ethnography (netnography) approach was utilized to explore the PGC and health communication in the online hypertension community. The final database included 300 randomly sampled threads and their 3,187 reply posts and was further analyzed from three perspectives: health information needs, attitudes and psychological reactions to hypertension and social support exchange.

Findings

The members' health information needs were mainly concentrated on five aspects: causes, symptoms, measuring instrument, tests and diagnosis and treatment. Their attitudes and psychological reactions to hypertension varied with the context, for example, disease stage, health condition. Within the health communication, three types of social support – information support, emotional support and network support – were generated, transmitted and exchanged among members.

Practical implications

OHCs are able to serve as important source of health information and tool for health education. The implications and suggestions for health promotion of individuals, health information services optimization of OHCs and national health strategy plans were also discussed.

Originality/value

This is the first netnography study in information field on Chinese online hypertension community. This study provides a new perspective to explore the needs, attitudes and social support behaviors of Chinese hypertension population and also enables the Chinese experience of using OHCs to reduce health disparities to come to the world.

Information behaviour of prison inmates in Malawi

The study examined the information behaviour of Mzimba prison inmates focusing on the research themes which are information needs, sources of information, and the barriers to seeking and using information of Mzimba prison inmates. A qualitative approach was used coupled with a case study design. Data were collected through focus group discussions and interviews from 12 inmates and two prison teaching staff respectively. The study found that health information, education information and spiritual information are the major information needs of Mzimba prison inmates. The study also found that the majority of respondents agreed that the six popular sources of information are their friends, teachers, radio, television, books and newspapers. However, the study concludes that Mzimba prison (library) fails to fulfil its role as a source of information and in meeting the information needs of inmates due to challenges of lack of information resources, limited time available for inmates to search for information, poor services and lack of funding for the school and library. The study recommends that the Malawi Prison Service should engage some stakeholders such as the Malawi National Library Services, National Initiative for Civic Education and Mzuzu University Library and Learning Resources Centre to support prison libraries with the provision of information resources to meet the information needs of inmates. The study further recommends that the Malawi Prison Service Command should lobby for financial support in order to hire qualified and capable librarians and teachers to manage prison libraries and schools.

Can Mobile Apps Motivate Fitness Tracking? A Study of Technological Affordances and Workout Behaviors

Can workout apps actually motivate users to sustain an exercise routine? If so, what are the key characteristics of these apps that engage long-term users? We conducted a content analysis to find out. Guided by the Motivational Technology Model and Self-Determination Theory, we explored the relationship between technological affordances of BodySpace, a highly ranked body building and weightlifting app, and behavioral outcomes (number of workouts tracked, weight lifted, and cardio hours) and goal attainment rate (percentage of body fat and weight goal achieved). A total of 682 profiles were used for analysis, revealing that the use of features of the app that elicit relatedness, autonomy, and competence predicted exercise outcomes. However, these relationships were moderated by gender, consistent with prior research on the differential workout motivations between males and females.

Factors driving continued use of online health promotion competitions

Purpose

Gamification elements have been increasingly used in online weight-loss communities to help users lose weight. The purpose of this paper is to systemically examine whether and how social interactions influence users’ continued participation in the context of online weight-loss competitions (OWCs).

Design/methodology/approach

This study empirically investigated sustained involvement in OWCs using a Cox proportional hazards model. Additionally, the research utilized a text-mining technique to identify various types of social support and explored their roles in sustaining participation behavior in OWCs.

Findings

Community response both within and outside OWCs positively influence users’ continued participation in OWCs. Moreover, whereas emotional support and companionship received within OWCs have a greater impact on users’ continued participation than informational support received within OWCs, informational support received outside OWCs has a greater impact on users’ continued participation than emotional support and companionship received outside OWCs.

Originality/value

This paper highlights users’ social needs in OWC engagement and provides empirical evidence on how different types and sources of social support influence continued participation behavior in OWCs. The research additionally provides management implications for online health community service providers.

Patient Continued Use of Online Health Care Communities: Web Mining of Patient-Doctor Communication

BACKGROUND

In practice, online health communities have passed the adoption stage and reached the diffusion phase of development. In this phase, patients equipped with knowledge regarding the issues involved in health care are capable of switching between different communities to maximize their online health community activities. Online health communities employ doctors to answer patient questions, and high quality online health communities are more likely to be acknowledged by patients. Therefore, the factors that motivate patients to maintain ongoing relationships with online health communities must be addressed. However, this has received limited scholarly attention.

OBJECTIVE

The purpose of this study was to identify the factors that drive patients to continue their use of online health communities where doctor-patient communication occurs. This was achieved by integrating the information system success model with online health community features.

METHODS

A Web spider was used to download and extract data from one of the most authoritative Chinese online health communities in which communication occurs between doctors and patients. The time span analyzed in this study was from January 2017 to March 2017. A sample of 469 valid anonymous patients with 9667 posts was obtained (the equivalent of 469 respondents in survey research). A combination of Web mining and structural equation modeling was then conducted to test the research hypotheses.

RESULTS

The results show that the research framework for integrating the information system success model and online health community features contributes to our understanding of the factors that drive patients' relationships with online health communities. The primary findings are as follows: (1) perceived usefulness is found to be significantly determined by three exogenous variables (ie, social support, information quality, and service quality; R²=0.88). These variables explain 87.6% of the variance in perceived usefulness of online health communities; (2) similarly, patient satisfaction was found to be significantly determined by the three variables listed above (R²=0.69). These variables explain 69.3% of the variance seen in patient satisfaction; (3) continuance use (dependent variable) is significantly influenced by perceived usefulness and patient satisfaction (R²=0.93). That is, the combined effects of perceived usefulness and patient satisfaction explain 93.4% of the variance seen in continuance use; and (4) unexpectedly, individual literacy had no influence on perceived usefulness and satisfaction of patients using online health communities.

CONCLUSIONS

First, this study contributes to the existing literature on the continuance use of online health communities using an empirical approach. Second, an appropriate metric was developed to assess constructs related to the proposed research model. Additionally, a Web spider enabled us to acquire objective data relatively easily and frequently, thereby overcoming a major limitation of survey techniques.

What is the Profile of Individuals Joining the KNEEguru Online Health Community? A Cross-Sectional Mixed-Methods Study

Background

The use of the Internet for seekers of health-related information provides convenience and accessibility to diverse sources (of variable quality) for many medical conditions. There is a suggestion that patients may find empowerment by engaging with Internet health care strategies and communities. The profile of consumers of online health information on knee pain has not been explored.

Objective

Our objective was to identify the characteristics and motivations of online health information-seekers accessing the online health community, KNEEguru (KG). The study was designed to obtain the respondents’ sociodemographic profile, together with their main reasons and motivations for joining such a community, their health information-seeking behavior, the extent of their knee problems, and their general Internet usage.

Methods

We undertook an online questionnaire survey, offered to users of the KG website from June to July 2012. A mix of open and closed questions was used to facilitate inductive enquiry. Quantitative responses were analyzed using univariate analysis; qualitative thematic analysis of the open responses was completed and a conceptual model was developed.

Results

One-hundred and fifty-two respondents took part (11.56% response rate, 152/1315), with a mean age of 40.1 years. Of this cohort, 61.2% were female, 68.4% were in domestic partnerships, 57.2% were employed, 75.0% had higher education qualifications, and 80.3% were of white/Caucasian ethnicity. Females were associated with joining KG in order to get emotional support from other users (OR 2.11, 95% CI 1.04 - 4.27, P=.04). Respondents’ self-perception of health was associated with reported quality of life (OR 10.86, 95% CI 3.85 - 30.43, P<.001). Facebook users were associated with joining KG to share experiences (OR 2.34, 95% CI 1.04 - 5.56, P=.03). Post-surgery respondents were associated with joining KG to compare symptoms with other users (OR 7.31, 95% CI 2.06 - 39.82, P<.001). Three key themes were induced: condition, emotion and support. Respondents expressed distress and frustration at uncertainty of prognosis around various knee conditions, with some users preferring to initially observe rather than engage. Conversely, a strong desire to inform and support other community members was stated with reciprocation of ideas and experiences. KG was conceptualized as a filter that takes an individual’s condition and emotional response to that condition as basis for support; this filter facilitated validation as the outcome of engagement.

Conclusions

This study, in line with wider literature, suggests that users of an online knee-specific community are typically female, middle-aged, white/Caucasian, married, employed, and have attained a level of higher education. These users demonstrate a pragmatic approach to health care information with altruistic motivations and a desire to share experiences as a means of validation. This finding emphasizes a means of promoting efficient and appropriate online health care, and demonstrates the benefits of the Internet as a viable complement to clinical engagement.