Health-related information seeking: Is it worth it?

"That's just Future Medicine" - a qualitative study on users' experiences of symptom checker apps

BACKGROUND

Symptom checker apps (SCAs) are mobile or online applications for lay people that usually have two main functions: symptom analysis and recommendations. SCAs ask users questions about their symptoms via a chatbot, give a list with possible causes, and provide a recommendation, such as seeing a physician. However, it is unclear whether the actual performance of a SCA corresponds to the users' experiences. This qualitative study investigates the subjective perspectives of SCA users to close the empirical gap identified in the literature and answers the following main research question: How do individuals (healthy users and patients) experience the usage of SCA, including their attitudes, expectations, motivations, and concerns regarding their SCA use?

METHODS

A qualitative interview study was chosen to clarify the relatively unknown experience of SCA use. Semi-structured qualitative interviews with SCA users were carried out by two researchers in tandem via video call. Qualitative content analysis was selected as methodology for the data analysis.

RESULTS

Fifteen interviews with SCA users were conducted and seven main categories identified: (1) Attitudes towards findings and recommendations, (2) Communication, (3) Contact with physicians, (4) Expectations (prior to use), (5) Motivations, (6) Risks, and (7) SCA-use for others.

CONCLUSIONS

The aspects identified in the analysis emphasise the specific perspective of SCA users and, at the same time, the immense scope of different experiences. Moreover, the study reveals ethical issues, such as relational aspects, that are often overlooked in debates on mHealth. Both empirical and ethical research is more needed, as the awareness of the subjective experience of those affected is an essential component in the responsible development and implementation of health apps such as SCA.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00022465. 07/08/2020.

Cultural Differences in Cancer Information Acquisition: Cancer Risk Perceptions, Fatalistic Beliefs, and Worry as Predictors of Cancer Information Seeking and Avoidance in the U.S. and China

Cancer is one of the most common causes of death in China and the United States. Past studies found that cancer risk perceptions, fatalistic beliefs, and worry were prominent predictors of health-related behaviors. Perceived cancer risks, fatalistic beliefs, and worry were associated with cancer information acquisition in the United States. However, little is known about whether these factors played comparable roles in China. This study investigates the psychological antecedents of cancer information acquisition using data from Health Information National Trends Surveys (HINTS) in both countries. Results showed that cancer worry was negatively related to cancer information avoidance in the U.S. but positively related to information avoidance in China. Also, whereas cancer fatalistic beliefs were negatively associated with cancer information seeking in the U.S., the relationships between fatalistic beliefs and cancer information seeking exhibited more complex patterns in China. Implications for cancer communication in different cultures are discussed.

Fear of Zika: Information Seeking as Cause and Consequence

This study examined the relationship between information seeking and fear during the Zika-induced global health crisis. A longitudinal survey of women in the Southern U.S. (N = 306) was conducted in 2016, beginning just days after the World Health Organization declared Zika a global crisis. The data showed that time 1 fear stimulated information seeking at time 2 and that time 2 information seeking caused fear at time 3. This pattern held regardless of whether participants were pregnant or planning to become pregnant (high personal relevance) versus neither (low personal relevance). The findings are at odds with most theories of fear appeals and only partially supportive of contemporary models of information seeking. From an applied standpoint, the results suggest (a) that information seeking should not be assumed to produce uniformly attractive outcomes and (b) that, during a disease crisis, health agencies should anticipate proactive behaviors by members of the public and plan accordingly.

Preventive health care information and social media: Consumer preferences

The dissemination of preventive health care information (PHCI) can create social and economic value. Enhanced communication of health information depends upon the identification of effective channels and user preferences. Recognizing consumers find the internet and, increasingly, social media sites (Facebook and YouTube) to be important sources of PHCI, this research analyzed questionnaire responses from U.S. adults to identify the social media sites (SMSs), communication preferences, and sources consumers prefer when obtaining PHCI via social media.

Critical health response in the time of COVID-19: lessons from the past

This article examines the South African government’s response to COVID-19 by exploring the strong emphasis that has been placed on South Africans taking personal responsibility for good health outcomes. This emphasis is based on the principles of the traditional Health Belief Model which is a commonly used model in global health systems. More recently, there has been a drive towards other health behaviour change models, like the COM-B model and Behaviour Change Wheel (BCW); nonetheless, these remain entrenched within the principles of individual health responsibility. However, the South African experience with the HIV epidemic serves as a backdrop to demonstrate that holding people personally accountable for health behaviour changes has major pitfalls; health risk is never objective and does not take place outside of subjective experience. This article makes the argument that risk-taking health behaviour change in the South African context has to consider community empowerment and capacity building.

A systematic integrative review of cognitive biases in consumer health information seeking: emerging perspective of behavioral information research

Purpose

With the growing interest in behavioral health and medical decision-making, this systematic integrative review aims to understand research on cognitive biases in the context of consumer health information seeking and where future research opportunities may reside.

Design/methodology/approach

Following a systematic review protocol, 40 empirical research articles, out of 1,127 journal research papers from 12 academic databases, from 1995 to 2019, are included for review.

Findings

The study of cognitive biases in consumer health information seeking is a nascent and fast-growing phenomenon, with variety in publication venues and research methods. Among the 16 biases investigated, optimistic bias and confirmation bias have attracted most attention (46.9%). Researchers are most interested in specific disease/illness (35%) and the health factors of consumer products (17.5%). For theoretical presence, about one-third of the reviewed articles have cited behavioral economist Daniel Kahneman, although most of the references are the early works of Kahneman.

Research limitations/implications

As an emerging research area, there exists plenty of cognitive biases to be investigated in the context of health information seeking. In the meantime, the adoption of more recent theoretical insights such as nudge for debiasing may enrich this research area. Health communication scientists may find incorporating the behavioral decision research framework enriches the disciplinary inquiry of health information seeking, while information scientists could use it to commence the cognitive turn of information science evolution.

Originality/value

Through evidence-based understanding, this review shows the potential research directions that health communication scientists and information scientists could contribute to optimize health decisions through the adoption of behavioral decision research framework.

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.

From Risk Butterflies to Citizens Engaged in Risk Prevention in the Zika Virus Crisis: Focusing on Personal, Societal and Global Risk Perceptions

This study investigates how posting information about the Zika virus on social media, and receiving information about Zika through the same platforms, are associated with personal, societal and global risk perceptions, and whether different types of risk perceptions are related to information seeking and preventive behavior intentions. A survey of U.S. participants (N = 958) revealed that posting information on social media is positively associated with personal and societal risk perceptions but not with global risk perceptions. Receiving information through social media, however, is positively associated with personal, societal and global risk perceptions. Personal and societal risk perceptions are associated with high information seeking intentions, which in turn leads to preventive behavioral intentions. The results suggest that so-called risk butterflies-those who frequently post information on social media-relate the health crisis to themselves and to their communities, and that these are important motivations for information-seeking and risk preventive behavior.

Experiences With Wearable Activity Data During Self-Care by Chronic Heart Patients: Qualitative Study

Background

Most commercial activity trackers are developed as consumer devices and not as clinical devices. The aim is to monitor and motivate sport activities, healthy living, and similar wellness purposes, and the devices are not designed to support care management in a clinical context. There are great expectations for using wearable sensor devices in health care settings, and the separate realms of wellness tracking and disease self-monitoring are increasingly becoming blurred. However, patients’ experiences with activity tracking technologies designed for use outside the clinical context have received little academic attention.

Objective

This study aimed to contribute to understanding how patients with a chronic disease experience activity data from consumer self-tracking devices related to self-care and their chronic illness. Our research question was: “How do patients with heart disease experience activity data in relation to self-care and chronic illness?”

Methods

We conducted a qualitative interview study with patients with chronic heart disease (n=27) who had an implanted cardioverter-defibrillator. Patients were invited to wear a FitBit Alta HR wearable activity tracker for 3-12 months and provide their perspectives on their experiences with step, sleep, and heart rate data. The average age was 57.2 years (25 men and 2 women), and patients used the tracker for 4-49 weeks (mean 26.1 weeks). Semistructured interviews (n=66) were conducted with patients 2–3 times and were analyzed iteratively in workshops using thematic analysis and abductive reasoning logic.

Results

Of the 27 patients, 18 related the heart rate, sleep, and step count data directly to their heart disease. Wearable activity trackers actualized patients’ experiences across 3 dimensions with a spectrum of contrasting experiences: (1) knowing, which spanned gaining insight and evoking doubts; (2) feeling, which spanned being reassured and becoming anxious; and (3) evaluating, which spanned promoting improvements and exposing failure.

Conclusions

Patients’ experiences could reside more on one end of the spectrum, could reside across all 3 dimensions, or could combine contrasting positions and even move across the spectrum over time. Activity data from wearable devices may be a resource for self-care; however, the data may simultaneously constrain and create uncertainty, fear, and anxiety. By showing how patients experience self-tracking data across dimensions of knowing, feeling, and evaluating, we point toward the richness and complexity of these data experiences in the context of chronic illness and self-care.

Information seeking in the context of cigarette smoking: predictors from the Comprehensive Model of Information Seeking (CMIS)

Background: The CMIS indicates that key variables in actively obtaining information on cigarette smoking are demographics, direct experience, salience, and beliefs, which affects subsequent evaluations and utility of information. Method: Cross-sectional data were drawn from the HINTS-FDA 2015 national survey in which a stratified random sample of the U.S. postal addresses (N = 3,738) self-administered a mailed paper questionnaire. Path analysis was conducted to test the CMIS. Results: Age, income, education, sexual orientation, beliefs about behavior change, and salience are significant predictors of perceived utility of information.Direct predictors of information seeking on health effects are comprehension of information (β = .06, 95% CI: .02-.09, p < .05), trust in information sources (β = .23, 95% CI: .18-.276, p < .01), and confidence in obtaining information (β = .10, 95% CI: .047-.160, p < .05). The final model produced fit indices of c² = 356.48, df = 24, CFI = .91, RMSEA = .061 (95% CI: .055-.067), R² = .098. Conclusions: The CMIS is a valid theoretical framework in predicting information seeking on cigarette smoking. This study closes a gap in the literature by addressing key factors simultaneously that influence information seeking on health effects and cessation of cigarette smoking.

Health-Information Seeking and Intention to Quit Smoking: Do Health Beliefs Have a Mediating Role?

Background:

Smoking is a leading cause of preventable deaths. Smoking cessation can reduce the risk of smoking-associated disease and death. But smoking cessation involves behaviour change. Existing research indicates that health-information seeking and health-promoting behaviours can be positively associated. However, in the context of smoking, the relationship between seeking health information and intending to quit smoking remains only partially understood.

Aim:

This study aimed to examine the relationship between seeking health information and intending to quit smoking and to determine whether this relationship is mediated by health beliefs.

Methods:

We used data from the fourth cycle of the US National Cancer Institute’s Health Information National Trends Survey (HINTS). Logistic regression was used to assess the independent variable (ie, health-information seeking) and dependent variable (ie, intention to quit smoking) as mediated by health belief.

Results:

Our findings suggest that smokers who seek health information have a 2.67 times higher odds of intending to quit smoking than smokers who do not seek health information. However, health beliefs do not have an intervening effect between seeking health information and intending to quit smoking.

Discussion:

Seeking health information is important in predicting attempts to quit smoking, regardless of the smokers’ pre-existing health beliefs. Our findings support cessation efforts that encourage smokers to seek health information. Determining optimal ways to encourage smokers to seek smoking-related information could support achieving and maintaining smoking cessation.

Conclusion:

Cessation programmes and policies should encourage smokers to seek health information. Additional research should further examine smokers’ motivators and cues for health-information seeking and should further probe smokers’ beliefs about the risks of smoking.

Valuing Health Surveillance as an Information System: Interdisciplinary Insights

The economic evaluation of health surveillance systems and of health information is a methodological challenge, as for information systems in general. Main present threads are considering cost-effectiveness solutions, minimizing costs for a given technically required output, or cost-benefit analysis, balancing costs with economic benefits of duly informed public interventions. The latter option, following a linear command-and-control perspective, implies considering a main causal link between information, decision, action, and health benefits. Yet, valuing information, taking into account its nature and multiple sources, the modalities of its processing cycle, from production to diffusion, decentralized use and gradual building of a shared information capital, constitutes a promising challenge. This work proposes an interdisciplinary insight on the value of health surveillance to get a renewed theoretical framework integrating information and informatics theory and information economics. The reflection is based on a typological approach of value, basically distinguishing between use and non-use values. Through this structured discussion, the main idea is to expand the boundaries of surveillance evaluation, to focus on changes and trends, on the dynamic and networked structure of information systems, on the contribution of diverse data, and on the added value of combining qualitative and quantitative information. Distancing itself from the command-and-control model, this reflection considers the behavioral fundaments of many health risks, as well as the decentralized, progressive and deliberative dimension of decision-making in risk management. The framework also draws on lessons learnt from recent applications within and outside of health sector, as in surveillance of antimicrobial resistance, inter-laboratory networks, the use of big data or web sources, the diffusion of technological products and large-scale financial risks. Finally, the paper poses the bases to think the challenge of a workable approach to economic evaluation of health surveillance through a better understanding of health information value. It aims to avoid over-simplifying the range of health information benefits across society while keeping evaluation within the boundaries of what may be ascribed to the assessed information system.

Applying the Modified Comprehensive Model of Information Seeking to Online Health Information Seeking in the Context of India

This study extends the Comprehensive Model of Information Seeking (CMIS) to online health information seeking in the context of India. This study considers the Internet (i.e., media) use an antecedent factor and the personal relevance factor salience is separated into two dimensions - susceptibility and severity. Structural equation modeling analysis (N = 990) tested the associations between health-related antecedents, information-carrier factors, and their direct effects on online information seeking. The results among online health information seekers in India showed significant relationships between length and frequency of media use and self-efficacy to engage in preventive behavior to the information carrier utility. As predicted, demographics have no significant relationship with utility of the Internet, and direct experience with illness resulted in negative relationship with the Internet utility. Contrary to expectations, susceptibility and severity produced negative relationships with the Internet utility. Result shows that both information-carrier factors - characteristics related to trust and utility related to perceived usefulness and relevance of information - directly affect online health-information-seeking behavior. Unlike the original CMIS that primarily focused on specific illnesses, the current modified CMIS can be adapted and tailored to general online health-information-seeking behavior.

Information Seeking Motivation Scale development: a self-determination perspective

Purpose

Using self-determination motivation theory as a theoretical framework, the purpose of this paper is to examine information seeking motivation at the domain level in higher education setting.

Design/methodology/approach

Confirmatory factor analysis was used to validate the Information Seeking Motivation Scale – College Version (ISMS – C).

Findings

ISMS – C was validated in the information seeking context. Consistent with self-determination theory (SDT), the results imply that students approach research tasks for both controlled and autonomous reasons.

Research limitations/implications

All constructs representing extrinsic and intrinsic motivation on a continuum were confirmed. However, amotivation proved difficult to define with the current sample. Additional studies need to be conducted in higher education setting in order to confirm its existence.

Practical implications

Given that the situational motivation is contingent on domain-level motivation, the ISMS – C scale can be helpful in promoting lasting intrinsic information seeking motivation at that level.

Originality/value

Consistent with the subjectivist orientation in information sciences which aims to account for cognitive and affective forces behind information need, ISMS constructed in the current study is one of the first measurement instruments to account for a spectrum of information seeking motivations at the domain level.

Designing Health Websites Based on Users' Web-Based Information-Seeking Behaviors: A Mixed-Method Observational Study

Background

Laypeople increasingly use the Internet as a source of health information, but finding and discovering the right information remains problematic. These issues are partially due to the mismatch between the design of consumer health websites and the needs of health information seekers, particularly the lack of support for “exploring” health information.

Objective

The aim of this research was to create a design for consumer health websites by supporting different health information–seeking behaviors. We created a website called Better Health Explorer with the new design. Through the evaluation of this new design, we derive design implications for future implementations.

Methods

Better Health Explorer was designed using a user-centered approach. The design was implemented and assessed through a laboratory-based observational study. Participants tried to use Better Health Explorer and another live health website. Both websites contained the same content. A mixed-method approach was adopted to analyze multiple types of data collected in the experiment, including screen recordings, activity logs, Web browsing histories, and audiotaped interviews.

Results

Overall, 31 participants took part in the observational study. Our new design showed a positive result for improving the experience of health information seeking, by providing a wide range of information and an engaging environment. The results showed better knowledge acquisition, a higher number of page reads, and more query reformulations in both focused and exploratory search tasks. In addition, participants spent more time to discover health information with our design in exploratory search tasks, indicating higher engagement with the website. Finally, we identify 4 design considerations for designing consumer health websites and health information–seeking apps: (1) providing a dynamic information scope; (2) supporting serendipity; (3) considering trust implications; and (4) enhancing interactivity.

Conclusions

Better Health Explorer provides strong support for the heterogeneous and shifting behaviors of health information seekers and eases the health information–seeking process. Our findings show the importance of understanding different health information–seeking behaviors and highlight the implications for designers of consumer health websites and health information–seeking apps.

Hypoglycemia-related information seeking among informal caregivers of type 2 diabetes patients: Implications for health education

•

We examined information seeking and knowledge about hypoglycemia among caregivers.

•

Nearly two thirds of family members and friends actively sought information.

•

Caregivers' knowledge about symptoms and treatments was found to be insufficient.

•

Increased information seeking is associated with higher health literacy levels.

Aims

To examine information seeking and knowledge about hypoglycemia among partners and family of type 2 diabetes patients and to identify associations between information seeking, knowledge and demographic, and disease-related characteristics.

Methods

Caregivers of adults with type 2 diabetes (N = 488) completed surveys assessing information seeking, knowledge of hypoglycemia symptoms and treatment, perceived competence, demographic information, and diabetes-related characteristics. Hierarchical and logistic regressions were used for data analysis.

Results

Nearly two thirds of family members and friends actively sought information about hypoglycemia, while health professionals and print media were reported as the main sources. Many respondents (74.5%) were able to identify at least one correct warning sign. But 32% could not state any correct treatment measures. Health professionals were the main and most helpful source of their knowledge. Education, past experience with hypoglycemia, and comprehension of information were associated with knowledge about treatment. Caregivers' perceived competence about hypoglycemia correlated with medical education, information-seeking, and comprehension of information.

Conclusions

Our results indicate the importance of the hypoglycemia-related information seeking of caregivers in managing incidents of hypoglycemia. These findings suggest the need to consider caregivers' health knowledge when developing health education programs in diabetes care. More attention must be focused on providing interventions that motivate information seeking and improve the comprehension of information. Interventions should inform caregivers about hypoglycemia to enhance their knowledge.

Female media use behavior and agreement with publicly promoted agenda-specific health messages

This study set out to explore the relationship between female media use behavior and agreement with agenda-specific publicly promoted health messages. A random digit dial telephone cross-sectional survey was conducted using a nationally representative sample of female residents aged 25 and over. Respondents' agreement with health messages was measured by a six-item Health Information Scale (HIS). Data were analyzed using chi-square tests and multiple logistic regression. This survey achieved a response rate of 86% (n = 1074). In this study the longest duration of daily television news watching (OR = 2.32), high self-efficacy (OR = 1.56), and greater attention to medical and health news (OR = 5.41) were all correlates of greater agreement with the selected health messages. Surprisingly, Internet use was not significant in the final model. Many women that public health interventions need to be targeting are not receptive to health information that can be accessed through Internet searches. However, they may be more readily targeted by television campaigns. Agenda-specific public health campaigns aiming to empower women to serve as nodes of information transmission and achieve efficient trickle down through the family unit might do better to invest more heavily in television promotion.