The influence of online health information on health decisions: A systematic review

Content accuracy and readability of dietary advice available on webpages: A systematic review of the evidence

BACKGROUND

Concerns have been raised regarding the quality of health information published on the World Wide Web, while studies accumulating similar evidence for nutrition-related information are scarce. The present review aimed to systematically accumulate and discuss the findings of studies evaluating the content quality of websites publishing nutrition-related information, based on the PRISMA statement.

METHODS

Studies that have assessed the accuracy and readability of dietary advice published on websites/webpages were evaluated. The SPIDER framework was used for the systematic search of studies, and those that evaluated websites/webpages that did not contain nutritional information, were videos or social media, referred to health professionals, or contained information on a specific theme (e.g., dietary supplements), were excluded.

RESULTS

Twenty-nine studies were included in this review, assessing information, published mainly in English, on 18 different diet-related topics. Twenty of them classified websites and reported, also, results per category. Inconsistent information has been found on 16%-49.6% of websites, with this percentage rising to 54%-94% in the case of 'weight loss' information. Purely congruent with guidelines information was found on 18%-39.7% of websites. Commercial sites were inferior in terms of quality to the rest. The readability level was estimated as higher than the recommended in 9 out of 11 studies that assessed it.

CONCLUSIONS

Results of the present systematic review indicate that inaccurate and hard-to-read dietary advice is found on many websites, regardless of the dietary topic.

Navigating Disagreements on Health Information: How Patients With Cancer Perceive Health Care Providers' Approaches to Discussing Patient-Identified Information

PURPOSE

Although publicly available cancer-related information online and offline could help patients make informed decisions, it also poses challenges due to prevalent misinformation. Patients need proper provider guidance to ensure they use valid and relevant information in decisions. We identify effective communication approaches for providers when (1) discussing patient-identified information and (2) disagreeing with it.

METHODS

From June to August 2023, people living with cancer were reached via online communities and asked first about their actual experiences discussing patient-identified information with their providers. Respondents were then randomly assigned into an experiment with three hypothetical scenarios where providers disagreed with patient-identified information. Provider responses included (1) dismissal, (2) explanation, and (3) explanation with relationship-building elements. Pearson correlation and multivariable analysis of variance were used to evaluate differences in patient perceptions.

RESULTS

One hundred seventy-five respondents completed the survey. Mean age: 53 years; 45% female; and 88% White, 10% Black, and 2% others. Forty-six percent held Bachelor's degrees or higher, 11% lived rurally, 36% reported financial difficulties, and 46% rated their health as good/excellent. Between 31% and 37% of respondents reported their provider used communication approaches that negatively correlated with discussion outcomes. The approaches included avoidance of such conversations due to limited time, discouragement of future information searches, or judgmental comments. In the experiment, respondents randomly assigned to receive relationship-building elements were significantly more comfortable sharing information, felt more satisfied, respected, and trusted their provider's opinion more than those receiving the dismissal scenario. The explanation scenario was not perceived differently compared with the dismissal scenario.

CONCLUSION

More than a third of respondents reported negative communication when sharing patient-identified information with their provider. Provider prioritization of relationship-building alongside explanations could foster trust and facilitate open information exchange, supporting informed decisions.

Health information orientation and health literacy as determinants of health promotion behaviors in adolescents: a cross-sectional study

Introduction

This cross-sectional study aimed to identify the impact of health information orientation and health literacy on adolescents' health-promoting behaviors.

Methods

We enrolled 149 middle school students from an urban city in South Korea through convenience sampling. The data was collected in October 2022 using a self-reported questionnaire. Health information orientation was measured using the Health Information Orientation Instrument (Cronbach's α = 0.86). Health literacy was assessed with the Korean Adolescent Health Literacy Scale (KR-20 = 0.66), and health promotion behaviors were evaluated using the Adolescent Health Promotion Scale-Short Form (Cronbach's α = 0.89). Analysis methods included independent t-tests, one-way ANOVA, and multiple regression.

Results

Results indicated significant differences in health promotion behaviors based on perceived health status, economic status, primary health-related information provider, and health literacy. Health information orientation showed a strong positive correlation with health promotion behaviors. The factors that influenced health promotion behaviors were health information orientation, primary information provider, economic status, and health literacy.

Discussion

Findings suggest that school and community health promotion programs should engage adolescents and parents to enhance health literacy and proactive information-seeking behaviors for improving the health outcomes of adolescents.

ChatGPT and oral cancer: a study on informational reliability

BACKGROUND

Artificial intelligence (AI) and large language models (LLMs) like ChatGPT have transformed information retrieval, including in healthcare. ChatGPT, trained on diverse datasets, can provide medical advice but faces ethical and accuracy concerns. This study evaluates the accuracy of ChatGPT-3.5's answers to frequently asked questions about oral cancer, a condition where early diagnosis is crucial for improving patient outcomes.

METHODS

A total of 20 questions were asked to ChatGPT-3.5, selected from Google Trends and questions asked by patients in the clinic. The responses provided by ChatGPT were evaluated for accuracy by medical oncologists and oral and maxillofacial radiologists. Inter-rater agreement was assessed using Fleiss's and Cohen kappa tests. The scores given by the specialties were compared with the Mann-Whitney U test. The references provided by ChatGPT-3.5 were evaluated for authenticity.

RESULTS

Of the 80 responses from 20 questions, 41 (51.25%) were rated as very good, 37 (46.25%) as good, 2 (2.50%) as acceptable. There was no significant difference between oral and maxillofacial radiologists and medical oncologists in all 20 questions. Of the 81 references to ChatGPT-3.5 answers, only 13 were scientific articles, 10 were fake, and the remaining references were data from websites.

CONCLUSION

ChatGPT provided reliable information about oral cancer and did not provide incorrect information and suggestions. However, all information provided by ChatGPT is not based on real references.

Detection of differences in physical symptoms between depressed and undepressed patients with breast cancer: a study using K-medoids clustering

BACKGROUND

To detect the differences in physical symptoms between depressed and undepressed patients with breast cancer (BC), including common symptoms, co-occurring symptoms, and symptom clusters based on texts derived from social media and expressive writing.

METHODS

A total of 1830 texts from social media and expressive writing were collected. The Chi-square test was used to compare the frequency of physical symptoms between depressed and undepressed patients with BC. Symptom lexicon of BC and K-medoids Clustering were used for mining physical symptoms and cluster analysis.

RESULTS

The common physical symptoms reported by texts included general pains (59.38%), fatigue (26.60%), vomiting (24.82%), swelling of limbs (21.69%), difficulty sleeping (21.56%), nausea (16.78%), alopecia (15.14%), loss of appetite (13.78%), dizziness (11.60%), and concentration problems (11.19%). The frequency of difficulty sleeping (depressed 28.40%; undepressed 18.16%; P = 0.002) in depressed patients was higher than undepressed patients with BC. High co-occurrence was observed in both commonly mentioned symptoms and those less commonly mentioned but frequently co-occurring with them. There were 5 symptom clusters identified in depressed patients and 6 symptom clusters in undepressed patients. Pain-related symptom cluster and gastrointestinal symptom cluster were both identified in the depressed and undepressed patients. The novel immune system impairment symptom cluster consisting of bleeding and fever was found in the undepressed patients.

CONCLUSIONS

This study found that difficulty sleeping was reported more frequently, and identified difficulty sleeping-pain symptom cluster in depressed patients. The novel immune system impairment symptom cluster in undepressed patients was detected. Healthcare providers can provide targeted care to depressed and undepressed patients based on these differences. These findings demonstrate that social media can provide new perspectives on symptom experiences. The combination of digital tools and traditional clinical tools for symptom management in follow-up has great potential in the future.

CLINICAL TRIAL NUMBER

Not applicable.

Sounding out solutions: using SONAR to connect participants with relevant healthcare resources

OBJECTIVE

This article outlines a scalable system developed by the All of Us Research Program's Genetic Counseling Resource to vet a large database of healthcare resources for supporting participants with health-related DNA results.

MATERIALS AND METHODS

After a literature review of established evaluation frameworks for health resources, we created SONAR, a 10-item framework and grading scale for health-related participant-facing resources. SONAR was used to review clinical resources that could be shared with participants during genetic counseling.

RESULTS

Application of SONAR shortened resource approval time from 7 days to 1 day. About 256 resources were approved and 8 rejected through SONAR review. Most approved resources were relevant to participants nationwide (60.0%). The most common resource types were related to support groups (20%), cancer care (30.6%), and general educational resources (12.4%). All of Us genetic counselors provided 1161 approved resources during 3005 (38.6%) consults, mainly to local genetic counselors (29.9%), support groups (21.9%), and educational resources (21.0%).

DISCUSSION

SONAR's systematic method simplifies resource vetting for healthcare providers, easing the burden of identifying and evaluating credible resources. Compiling these resources into a user-friendly database allows providers to share these resources efficiently, better equipping participants to complete follow up actions from health-related DNA results.

CONCLUSION

The All of Us Genetic Counseling Resource connects participants receiving health-related DNA results with relevant follow-up resources on a high-volume, national level. This has been made possible by the creation of a novel resource database and validation system.

From Online to Offline: How Different Sources of Online Health Information Seeking Affect Patient-Centered Communication in Chinese Older Adults? The Roles of Patient Activation and Patient-Provider Discussion of Online Health Information

Despite the increasing prevalence of online health information seeking (OHIS) among older adults, its impact on patient-centered communication (PCC) outcomes remains unclear. Drawing from Street's ecological framework of communication in medical encounters, the present study examined the mediation role of patient activation in the relationship between OHIS across three media channels - social media, search engines, and mobile health applications (mHealth apps) - and PCC. Furthermore, it examines the moderation effect of patient-provider discussions of online health information. A national survey of 916 older Chinese adults aged 60-78 was conducted. The findings indicate that OHIS across the three channels can indirectly enhance PCC through patient activation. Moreover, OHIS via mHealth apps is positively associated with PCC, while the relationship between OHIS via social media/search engines and PCC is not significant. The interaction between patients and healthcare providers regarding online health information positively moderated all indirect paths. Notably, a great proportion of older adults (77.7%) engaged in discussions about online health information with healthcare providers. These findings emphasize the importance of considering various media channels and highlight the pivotal role of patient activation in bridging the gap between OHIS and satisfactory healthcare interactions, especially in the Chinese context.

Oral Diabetes Medication Videos on Douyin: Analysis of Information Quality and User Comment Attitudes

BACKGROUND

Oral diabetes medications are important for glucose management in people with diabetes. Although there are many health-related videos on Douyin (the Chinese version of TikTok), the quality of information and the effects on user comment attitudes are unclear.

OBJECTIVE

The purpose of this study was to analyze the quality of information and user comment attitudes related to oral diabetes medication videos on Douyin.

METHODS

The key phrase "oral diabetes medications" was used to search Douyin on July 24, 2023, and the final samples included 138 videos. The basic information in the videos and the content of user comments were captured using Python. Each video was assigned a sentiment category based on the predominant positive, neutral, or negative attitude, as analyzed using the Weiciyun website. Two independent raters assessed the video content and information quality using the DISCERN (a tool for assessing health information quality) and PEMAT-A/V (Patient Education Materials Assessment Tool for Audiovisual Materials) instruments.

RESULTS

Doctors were the main source of the videos (136/138, 98.6%). The overall information quality of the videos was acceptable (median 3, IQR 1). Videos on Douyin showed relatively high understandability (median 75%, IQR 16.6%) but poor actionability (median 66.7%, IQR 48%). Most content on oral diabetes medications on Douyin related to the mechanism of action (75/138, 54.3%), precautions (70/138, 50.7%), and advantages (68/138, 49.3%), with limited content on indications (19/138, 13.8%) and contraindications (14/138, 10.1%). It was found that 10.1% (14/138) of the videos contained misinformation, of which 50% (7/14) were about the method of administration. Regarding user comment attitudes, the majority of videos garnered positive comments (81/138, 58.7%), followed by neutral comments (46/138, 33.3%) and negative comments (11/138, 8%). Multinomial logistic regression revealed 2 factors influencing a positive attitude: user comment count (adjusted odds ratio [OR] 1.00, 95% CI 1.00-1.00; P=.02) and information quality of treatment choices (adjusted OR 1.49, 95% CI 1.09-2.04; P=.01).

CONCLUSIONS

Despite most videos on Douyin being posted by doctors, with generally acceptable information quality and positive user comment attitudes, some content inaccuracies and poor actionability remain. Users show more positive attitudes toward videos with high-quality information about treatment choices. This study suggests that health care providers should ensure the accuracy and actionability of video content, enhance the information quality of treatment choices of oral diabetes medications to foster positive user attitudes, help users access accurate health information, and promote medication adherence.

The Quality and Cultural Safety of Online Osteoarthritis Information for Affected Persons and Health Care Professionals: Content Analysis

BACKGROUND

Osteoarthritis is more prevalent and severe among women than among men, but women are less likely to access early diagnosis and first-line management, particularly racialized immigrant women. Previous research advocated for greater access to culturally safe osteoarthritis information for both diverse women and health care professionals. The internet can reduce disparities by facilitating access to health information, but online materials can vary in quality.

OBJECTIVE

This study aimed to assess the quality and cultural safety of online osteoarthritis materials for persons affected by osteoarthritis and health care professionals.

METHODS

Content analysis was used to describe publicly available materials on osteoarthritis first-line management developed by Canadian organizations for affected persons or health care professionals. Searching, screening, and data extraction were performed in triplicate. We identified materials by searching Google, MEDLINE, and references of osteoarthritis-relevant guidelines and policies, and consulting our research team and collaborators. We assessed quality using DISCERN (University of Oxford) and a compiled framework for affected persons and health care professionals. We compiled frameworks to assess cultural safety. We derived an overall score, categorized as low (<50%), moderate (50%-69%), or high (≥70%+) for criteria met.

RESULTS

After screening 176 items and eliminating 129, we included 47 osteoarthritis materials published between 2013 and 2023. Of those, 43 were for persons with osteoarthritis, most were developed by charities (n=31, 72.1%), based on expert advice (n=16, 55.2%), and in the format of booklets (n=15, 34.9%) or text on web pages (n=10, 23.3%). Of those, 23.3% (10/43) low, 46.5% (20/43) moderate, and 30.2% (13/43) high scored quality; and 25.6% (11/43), 48.8% (21/43), and 25.6% (11/43) were rated low, moderate, and high cultural safety, respectively. Of the 47 included osteoarthritis materials, 4 were for health care professionals. They were developed by a consortium (2/4, 50%), a charity (1/4, 25%), and a professional society (1/4, 25%), and largely based on expert advice (3/4, 75%). The format included infographics (3/4, 75%) and text on web pages (1/4, 25%). Of those, 25% (1/4), 25% (1/4), and 50% (2/4) were rated low, moderate, and high quality, respectively; and all were rated low for cultural safety. Quality and cultural safety did not appear to be associated with the characteristics of osteoarthritis materials (eg, type of developer, development method, and format).

CONCLUSIONS

Overall, included osteoarthritis materials for persons with osteoarthritis and health care professionals were of low to moderate quality and cultural safety. These findings reveal the need for further efforts to improve existing or develop new osteoarthritis materials for both affected persons, including ethnoculturally diverse immigrant women, and health care professionals. Further research is needed to assess the quality and cultural safety of osteoarthritis materials developed by organizations outside of Canada and to establish a framework or instrument to assess cultural safety in the osteoarthritis context.

Credibility, readability and content analysis of treatment recommendations for adolescents with nonspecific back pain published on consumer websites

BACKGROUND

Parents may seek out health information online when their adolescent has nonspecific back pain to better understand treatment options. Such information directed towards consumers has not been previously analysed.

METHODS

A descriptive cross-sectional content analysis was performed to describe the treatments recommended on consumer websites for nonspecific back pain in adolescents. The credibility and readability of the websites were also assessed. Systematic Google searches were completed in five countries, and relevant content from eligible web pages was analysed. An a priori codebook with 34 treatment-related codes was developed. Nine additional codes were inductively created during analysis. Credibility was assessed using the JAMA benchmark. Readability was assessed via the Flesch Kincaid Grade Level.

RESULTS

Of 245 web pages, 48 were deemed eligible and analysed. Of 43 treatment codes, 37 were present in at least one web page. The five most frequently identified codes were See the doctor/get a diagnosis (found on 85% of web pages), Ergonomics/posture/biomechanics (52%), Reassurance (48%), Physiotherapy (48%) and Non-prescription pharmaceuticals/supplements (46%). Only 21% of the web pages met all four JAMA benchmark criteria, and 15% cited at least one recent or high-quality source. The median Flesch Kincaid Grade Level score was 9.0 (range 3.5-12.9).

CONCLUSIONS

Parents of adolescents with nonspecific back pain may find that treatment recommendations published online are numerous and varied, with visits to the doctor encouraged. The credibility scores of these web pages are generally low, while the median reading level may be too high for the general population.

SIGNIFICANCE STATEMENT

This analysis reveals that public-facing websites with recommendations for treating adolescent nonspecific back pain do not cite the most recent, high-quality research. Although web pages correctly encourage physical activity and exercise over surgery and prescription medications, they do not reflect the psychologically informed or interdisciplinary care emphasized in recently published treatment recommendations. Clinicians must be aware that caregivers of their adolescent patients with nonspecific back pain may be exposed to online messages that encourage them to keep seeking a diagnosis.

Navigating Pregnancy: Information Sources and Lifestyle Behavior Choices-A Narrative Review

Background: Accessible health information during pregnancy is important to positively affect maternal and fetal health. However, the quality and accuracy of health information can greatly vary across numerous sources. This narrative review is aimed at summarizing the literature on pregnant individuals' information sources and how these sources influence their habits toward GWG, PA, and nutrition. Such data will highlight preferences and needs, reveal challenges, and identify opportunities for improvement. Methods: We searched PubMed for studies published in the last decade. Out of 299 studies initially identified, 20 (16 quantitative and four qualitative) met the eligibility criteria (investigating information sources and their influence on health habits toward GWG, PA, nutrition, pregnant participants, adequate data reporting, and being available in full text). Results: Primary sources of health information varied. The Internet (26%-97%) and healthcare providers (HCPs) (14%-74%) predominated, followed by family/friends (12%71%), books/magazines (49%-65%), and guidelines/brochures (25%-53%). Despite the widespread use of the Internet, HCPs were considered the most reliable source. The use of the Internet to retrieve health information was reported to be 2-4 h a week, and < 50% discussed the online information with their HCP. The Internet was also used as a supplementary resource on topics raised by HCPs. Regarding the influence on health habits, the Internet, HCPs, media, and family positively influenced GWG and promoted adherence to recommended guidelines (OR = 0.55-15.5). Only one study showed a positive association between Internet use and PA level. The Internet, media, HCPs, and information brochures were associated with better adherence to nutritional recommendations. Conclusions: Pregnant individuals relied on the Internet and HCP, with a preference for the Internet despite trust in midwives. Several sources of health information were positively associated with adherence to GWG and nutrition recommendations. Improving the quality of online information should be a priority for policymakers and health authorities.

AI in Neuro-Ophthalmology: Current Practice and Future Opportunities

BACKGROUND

Neuro-ophthalmology frequently requires a complex and multi-faceted clinical assessment supported by sophisticated imaging techniques in order to assess disease status. The current approach to diagnosis requires substantial expertise and time. The emergence of AI has brought forth innovative solutions to streamline and enhance this diagnostic process, which is especially valuable given the shortage of neuro-ophthalmologists. Machine learning algorithms, in particular, have demonstrated significant potential in interpreting imaging data, identifying subtle patterns, and aiding clinicians in making more accurate and timely diagnosis while also supplementing nonspecialist evaluations of neuro-ophthalmic disease.

EVIDENCE ACQUISITION

Electronic searches of published literature were conducted using PubMed and Google Scholar. A comprehensive search of the following terms was conducted within the Journal of Neuro-Ophthalmology: AI, artificial intelligence, machine learning, deep learning, natural language processing, computer vision, large language models, and generative AI.

RESULTS

This review aims to provide a comprehensive overview of the evolving landscape of AI applications in neuro-ophthalmology. It will delve into the diverse applications of AI, optical coherence tomography (OCT), and fundus photography to the development of predictive models for disease progression. Additionally, the review will explore the integration of generative AI into neuro-ophthalmic education and clinical practice.

CONCLUSIONS

We review the current state of AI in neuro-ophthalmology and its potentially transformative impact. The inclusion of AI in neuro-ophthalmic practice and research not only holds promise for improving diagnostic accuracy but also opens avenues for novel therapeutic interventions. We emphasize its potential to improve access to scarce subspecialty resources while examining the current challenges associated with the integration of AI into clinical practice and research.

Artificial intelligence chatbot performance in triage of ophthalmic conditions

BACKGROUND

Timely access to human expertise for affordable and efficient triage of ophthalmic conditions is inconsistent. With recent advancements in publicly available artificial intelligence (AI) chatbots, the lay public may turn to these tools for triage of ophthalmic complaints. Validation studies are necessary to evaluate the performance of AI chatbots as triage tools and inform the public regarding their safety.

OBJECTIVE

To evaluate the triage performance of AI chatbots for ophthalmic conditions.

DESIGN

Cross-sectional study.

SETTING

Single centre.

PARTICIPANTS

Ophthalmology trainees, OpenAI ChatGPT (GPT-4), Bing Chat, and WebMD Symptom Checker.

METHODS

Forty-four clinical vignettes representing common ophthalmic complaints were developed, and a standardized pathway of prompts was presented to each tool in March 2023. Primary outcomes were proportion of responses with the correct diagnosis listed in the top 3 possible diagnoses and proportion with correct triage urgency. Ancillary outcomes included presence of grossly inaccurate statements, mean reading grade level, mean response word count, proportion with attribution, and most common sources cited.

RESULTS

The ophthalmologists in training, ChatGPT, Bing Chat, and the WebMD Symptom Checker listed the appropriate diagnosis among the top 3 suggestions in 42 (95%), 41 (93%), 34 (77%), and 8 (33%) cases, respectively. Triage urgency was appropriate in 38 (86%), 43 (98%), and 37 (84%) cases for ophthalmology trainees, ChatGPT, and Bing Chat, correspondingly.

CONCLUSIONS

ChatGPT using the GPT-4 model offered high diagnostic and triage accuracy that was comparable with that of ophthalmology trainees with no grossly inaccurate statements. Bing Chat had lower accuracy and a tendency to overestimate triage urgency.

Physician Perspectives on Internet-Informed Patients: Systematic Review

BACKGROUND

The internet has become a prevalent source of health information for patients. However, its accuracy and relevance are often questionable. While patients seek physicians' expertise in interpreting internet health information, physicians' perspectives on patients' information-seeking behavior are less explored.

OBJECTIVE

This review aims to understand physicians' perceptions of patients' internet health information-seeking behavior as well as their communication strategies and the challenges and needs they face with internet-informed patients.

METHODS

An initial search in PubMed, Scopus, CINAHL, Communication and Mass Media Complete, and PsycINFO was conducted to collect studies published from January 1990 to August 1, 2022. A subsequent search on December 24, 2023, targeted recent studies published after the initial search cutoff date. Two reviewers independently performed title, abstract, and full-text screening, adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. Thematic analysis was then used to identify key themes and systematically categorize evidence from both qualitative and quantitative studies under these themes.

RESULTS

A total of 22 qualifying articles were identified after the search and screening process. Physicians were found to hold diverse views on patients' internet searches, which can be viewed as a continuous spectrum of opinions ranging from positive to negative. While some physicians leaned distinctly toward either positive or negative perspectives, a significant number expressed more balanced views. These physicians recognized both the benefits, such as increased patient health knowledge and informed decision-making, and the potential harms, including misinformation and the triggering of negative emotions, such as patient anxiety or confusion, associated with patients' internet health information seeking. Two communicative strategies were identified: the participative and defensive approaches. While the former seeks to guide internet-informed patients to use internet information with physicians' expertise, the latter aims to discourage patients from using the internet to seek health information. Physicians' perceptions were linked to their strategies: those holding positive views tended to adopt a participative approach, while those with negative views favored a defensive strategy. Some physicians claimed to shift between the 2 approaches depending on their interaction with a certain patient. We also identified several challenges and needs of physicians in dealing with internet-informed patients, including the time pressure to address internet-informed patient demands, a lack of structured training, and being uninformed about trustworthy internet sites that can be recommended to internet-informed patients.

CONCLUSIONS

This review highlights the diverse perceptions that physicians hold toward internet-informed patients, as well as the interplay between their perceptions, communication strategies, and their interactions with individual patients. Incorporating elements into the medical teaching curriculum that introduce physicians to reliable internet health resources for patient guidance, coupled with providing updates on technological advancements, could be instrumental in equipping physicians to more effectively manage internet-informed patients.

TRIAL REGISTRATION

PROSPERO CRD42022356317; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=356317.

Preferred sources of information on diabetes prevention programmes: a population-based cross-sectional study in Poland

OBJECTIVE

This study aimed to analyse preferred sources of information on diabetes prevention programmes and to identify sociodemographic determinants influencing these preferences among adults in Poland.

DESIGN

A cross-sectional survey was carried out between 15 and 18 September 2023 using a computer-assisted web interview. A self-prepared questionnaire included 10 questions on sources of information on type 2 diabetes prevention.

PARTICIPANTS

Data were obtained from 1046 adults (18-82 years); 53.4% were females.

RESULTS

Most respondents preferred email communication (46.4%), followed by a doctor or nurse (33.5%), and a letter or leaflet directly delivered to the mailbox (25.8%) for type 2 diabetes mellitus (DM2) prevention information. Younger respondents were more likely to indicate mass media (OR=1.81, 95% CI=1.12 to 2.95, p=0.01) and digital media (OR=1.65, 95% CI=1.02 to 2.67, p=0.04) as a source of information on DM2 prevention. Those who had higher education (OR=1.51, 95% CI=1.16 to 1.96, p=0.002), as well as those with chronic diseases (OR=1.50, 95% CI=1.14 to 1.97, p=0.004), were more likely to indicate digital media. Out of 10 different variables analysed in this study, passive occupational status (OR=1.43, 95% CI=1.04 to 1.96, p=0.03) as well as having chronic diseases (OR=1.51, 95% CI=1.16 to 1.96, p=0.002) were associated with higher odds of indicating healthcare workers as a preferred source of information. Marital status, having children, place of residence, household characteristics and financial status do not significantly decide communication preferences.

CONCLUSION

Communication on DM2 prevention should be adjusted to public preferences and expectations. Tailoring interventions to different demographic groups can enhance outreach and engagement. Email emerged as a popular choice, suggesting the potential of digital communication in preventive health programmes.

Decision-making for congenital anomalies diagnosed during pregnancy: a narrative review

PURPOSE

The purpose of this narrative review was to assess the limited literature on fetal anomalies diagnosed in the second trimester of pregnancy and parental decision-making and identify sources of information deemed as facilitators and barriers to medical decisions.

METHODS

This was a literature review of source material and information about fetal anomalies diagnosed in the second trimester of pregnancy, decision-making, decision tools or aids, and sources of information for anomalies. The search string used explored related peer-reviewed publications and systematic reviews between 2007 and 2024. We also reviewed references from publications meeting inclusion criteria. The search was conducted between June 2022 and February 2024. Exclusion criteria included conference abstracts, non-peer reviewed literature, and articles not available in English language. A total of 77 publications were identified by searching multiple databases using a predefined search string. The search encompassed full text articles from 2007 to 2024 and 11 full-text publications were ultimately included in the review. A list of 45 co-occurring keywords was generated from the included texts, with each keyword having a minimum of two co-occurrences.

RESULTS

Key themes identified included (1) the role of the clinician and need for development of professional knowledge and empathy surrounding discussion of fetal anomalies with patients; (2) information gathering, with individuals reporting use of multiple strategies to obtain information; while the majority found information satisfying, they preferred more details on diagnosis, long-term outcomes of the fetus/child and management of the pregnancy or termination process; and (3) decision-making, the path and process of how individuals made decisions about the pregnancy including quality of life, future fertility, and seeking other people's experiences.

CONCLUSION

Many factors contribute to an individual's decision-making after a diagnosis of a fetal anomalies diagnosed in the second trimester of pregnancy, ranging from personal beliefs and goals to shared experiences of others and access to care. Understanding how sources of information may be deemed both as facilitators and barriers to different individuals during the decision-making process is important for healthcare providers in order to understand how to most effectively support patients. There is a dearth of information on training healthcare professionals to provide support to patients facing these decisions.

Examining Healthcare Professionals' Communication Around Decision-Making with Internet-Informed Patients

In the last ten years the use of the internet as a health resource has transformed, and while patients increasingly consult online resources for health decision-making, less is known about how healthcare professionals (HCPs) currently discuss decision-making with internet informed patients (IIPs). In this paper we examine how HCPs perceive IIPs and specifically how bringing online information into appointments can prompt different communicative strategies around decision-making. Ten HCPs with experience working across different healthcare roles, took part in semi-structured interviews and discussed their interactions with IIPs around decision-making. Vignettes based on descriptions of real patients bringing online health information to their HCPs were used to prompt further discussion. The analysis identified two themes in relation to communication: (i) being honest about information sources and (ii) from compliance to co-construction: improving communication around decision-making. HCPs were overwhelmingly positive toward IIPs and encouraged patients to be transparent about their online searching to understand their motivations, priorities, and concerns. Although compliance remains part of the narrative, HCPs recognized practical ways in which discussing online health information could improve HCP-patient communication around shared decision-making. We discuss the findings in relation to early work on communicative strategies between HCP's and patients bringing resources to their consultations. We argue that for HCPs the concept of the internet as a provider of health information is no longer seen as inherently damaging or risky. There is growing acceptance of pre-consultation internet searching with the caveat that any information sourced online should inform rather than dictate decision-making with HCPs.

Health information-seeking behavior in patients with coronary artery disease: Activating methods

INTRODUCTION

Coronary artery disease (CAD) has a high mortality rate worldwide, and continuous health behavior practice and careful management are required owing to risks such as rapid changes in symptoms and emergency hospitalization. The utilization of health-related information is an important factor for long-term disease management in patients with CAD. For this purpose, an understanding of health information-seeking behavior is needed first.

METHODS

This study analyzed data from the 2021 Korea Medical Panel Survey, and logistic regression analysis was conducted to confirm the factors influencing the health information-seeking behavior of patients with CAD.

RESULTS

The health information-seeking behavior of patients with CAD differed according to demographic characteristics, and differences in preferred information use were confirmed. Finally, it was identified that insufficient levels of health literacy were a major reason for CAD patients not engaging in health information-seeking behaviors (OR, 0.17; 95% CI, 0.09-0.33; p < 0.001).

CONCLUSION

This study suggests that to improve health information-seeking behaviors, the application of education and intervention programs to increase the level of health literacy is necessary.

Development and Evaluation of a Clinician-Vetted Dementia Caregiver Resources Website: Mixed Methods Approach

BACKGROUND

About 11 million Americans are caregivers for the 6.7 million Americans currently living with dementia. They provide over 18 billion hours of unpaid care per year, yet most have no formal dementia education or support. It is extremely difficult for clinicians to keep up with the demand for caregiver education, especially as dementia is neurodegenerative in nature, requiring different information at different stages of the disease process. In this digital age, caregivers often seek dementia information on the internet, but clinicians lack a single, reliable compendium of expert-approved digital resources to provide to dementia caregivers.

OBJECTIVE

Our aim was to create a dementia caregiver resources website to serve as a hub for user-friendly, high-quality, and expert-reviewed dementia educational resources that clinicians can easily supply to family caregivers of people with dementia.

METHODS

An interdisciplinary website development team (representing dementia experts from occupational therapy, nursing, social work, geriatrics, and neurology) went through 6 iterative steps of website development to ensure resource selection quality and eligibility rigor. Steps included (1) resource collection, (2) creation of eligibility criteria, (3) resource organization by topic, (4) additional content identification, (5) finalize resource selection, and (6) website testing and launch. Website visits were tracked, and a 20-item survey about website usability and utility was sent to Veterans Affairs tele-geriatrics interdisciplinary specialty care groups.

RESULTS

Following website development, the dementia caregiver resource website was launched in February 2022. Over the first 9 months, the site averaged 1100 visits per month. The 3 subcategories with the highest number of visits were "general dementia information," "activities of daily living," and "self-care and support." Most (44/45, 98%) respondents agreed or strongly agreed that the website was easy to navigate, and all respondents agreed or strongly agreed that the resources were useful.

CONCLUSIONS

The iterative process of creating the dementia caregiver resources website included continuous identification, categorization, and prioritization of resources, followed by clinician feedback on website usability, accessibility, and suggestions for improvement. The website received thousands of visits and positive clinician reviews in its first 9 months. Results demonstrate that an expert-vetted, nationally, and remotely available resource website allows for easy access to dementia education for clinicians to provide for their patients and caregivers. This process of website development can serve as a model for other clinical subspecialty groups seeking to create a comprehensive educational resource for populations who lack easy access to specialty care.

Tracking Chinese Online Activity and Interest in Osteoporosis Using the Baidu Index

Introduction China's most widely used online search engine, Baidu (Baidu, Inc., Beijing, China), has developed a data collection and analysis tool called the Baidu Index for tracking Internet search trends. The purpose of this study was to examine the utility of the Baidu Index in tracking online osteoporosis information-seeking behavior and comprehending the traits and concerns of the Chinese population. Methods We used the search term "osteoporosis" for the Baidu Index for the years 2018-2022. The geographic and demographic distributions, search volumes, and demand maps were recorded. Results The popularity of the search term "osteoporosis" has increased over time. The search was mostly conducted among women aged 20-39 in northern China. The demand map revealed that the most significant concerns are related to the diagnosis, treatment, and etiology of osteoporosis. Conclusion The Baidu Index is a valuable tool for tracking online health information-seeking behavior among Chinese netizens. Online search trend data appears to reflect the geographic and demographic aspects of osteoporosis to a certain extent.

Online Health Information Seeking and Preventative Health Actions: Cross-Generational Online Survey Study

BACKGROUND

The popularity of online health information seeking (OHIS) has increased significantly owing to its accessibility and affordability. To facilitate better health management, it is essential to comprehend the generational differences in OHIS behavior and preventative health actions after seeking online health information (OHI).

OBJECTIVE

This study investigates the variations in OHIS and engagement in preventative health actions between 2 generations based on their technology use (digital natives [aged 18-42 years] and digital immigrants [aged ≥43 years]). Additionally, this research explores the mediating role of OHIS types on the generational effect on preventative health actions and the moderating role of OHI search frequency, gender, and the presence of chronic diseases on the generational effect on OHIS types and preventative health actions.

METHODS

A preregistered online survey was conducted on the Prolific online data collection platform using stratified sampling of 2 generations (digital natives and digital immigrants) from the United States in November 2023. Overall, 3 types of OHIS were collected: health wellness information search, health guidance information search, and health management information search. A 1-way analysis of covariance tested the generational differences in types of OHIS and preventative health actions, and a 2-way analysis of covariance tested the moderating role of OHIS search frequency, gender, and the presence of chronic diseases using 7 control variables. The PROCESS Macro Model 4 was used to conduct mediation analyses, testing OHI search types as mediators. Linear regression analyses tested age as a predictor of OHIS and preventative health actions.

RESULTS

The analysis of 1137 responses revealed generational differences in OHIS. Digital natives searched for health wellness information more frequently (P<.001), whereas digital immigrants searched for health guidance (P<.001) and health management information (P=.001) more frequently. There were no significant differences between the 2 generations regarding preventative health actions (P=.85). Moreover, all 3 types of OHIS mediated the relationship between generational differences and preventative health actions. Furthermore, as people aged, they searched for significantly less health wellness information (P<.001) and more health guidance (P<.001), and health management information (P=.003). Age was not a significant predictor of preventative health actions (P=.48). The frequency of OHI searches did not moderate the effect of generations on OHIS types and preventative health actions. Gender only moderated the relationship between generation and health guidance information search (P=.02), and chronic diseases only moderated the relationship between generation and health wellness information search (P=.03).

CONCLUSIONS

To the best of our knowledge, this study is the first to explore how 2 digital generations vary in terms of searching for OHI and preventative health behaviors. As the older adult population grows, it is crucial to understand their OHIS behavior and how they engage in preventative health actions to enhance their quality of life.

Health Beliefs, Protective Behaviors, and Information-Seeking

BACKGROUND

The outbreak of COVID-19 caused severe damage to public health globally and served as a stark reminder of the potential for future pandemics. Promoting protective behaviors to prevent the spread of any contagious disease thus remains a priority. Although research has shown that health beliefs can affect protective behaviors, few studies have examined the role of information-seeking in this relationship.

OBJECTIVES

On the basis of the health belief model, this research focused on whether health beliefs affect personal protective behaviors through health information-seeking behaviors.

METHODS

This cross-sectional study with a causal-comparative design used an online questionnaire to investigate the Taiwanese public's health beliefs, protective behaviors, and information-seeking behaviors during the COVID-19 pandemic. Data were analyzed using descriptive statistics and multiple regression analysis.

RESULTS

Between September 2021 and January 2022, 322 valid questionnaires were collected. The results revealed that the effects of two health beliefs-self-efficacy and perceived benefits-on handwashing, social distancing, practicing good cough etiquette, and keeping one's environment clean and well ventilated were partially mediated by the frequency of official information-seeking.

DISCUSSION

Results of this study support the regular and timely promotion of pandemic prevention measures through official sites. Promoting official information-seeking can help enhance protective behaviors.

Exploring Diagnostic Precision and Triage Proficiency: A Comparative Study of GPT-4 and Bard in Addressing Common Ophthalmic Complaints

In the modern era, patients often resort to the internet for answers to their health-related concerns, and clinics face challenges to providing timely response to patient concerns. This has led to a need to investigate the capabilities of AI chatbots for ophthalmic diagnosis and triage. In this in silico study, 80 simulated patient complaints in ophthalmology with varying urgency levels and clinical descriptors were entered into both ChatGPT and Bard in a systematic 3-step submission process asking chatbots to triage, diagnose, and evaluate urgency. Three ophthalmologists graded chatbot responses. Chatbots were significantly better at ophthalmic triage than diagnosis (90.0% appropriate triage vs. 48.8% correct leading diagnosis; p < 0.001), and GPT-4 performed better than Bard for appropriate triage recommendations (96.3% vs. 83.8%; p = 0.008), grader satisfaction for patient use (81.3% vs. 55.0%; p < 0.001), and lower potential harm rates (6.3% vs. 20.0%; p = 0.010). More descriptors improved the accuracy of diagnosis for both GPT-4 and Bard. These results indicate that chatbots may not need to recognize the correct diagnosis to provide appropriate ophthalmic triage, and there is a potential utility of these tools in aiding patients or triage staff; however, they are not a replacement for professional ophthalmic evaluation or advice.

Evaluation of quality and readability of internet information on voice disorders

OBJECTIVES

The purpose of this study is to evaluate the readability and quality of Internet information related to vocal health, voice disorders and voice therapy.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Eighty-two websites were included. Websites were then analyzed; their origin (clinic/hospital, non-profit, government), quality (Health On the Net [HON] certification and DISCERN scores) and readability (Ateşman readability formula and Bezirci-Yılmaz new readability formula) were assessed. Statistical analysis was used to examine differences between website origin and quality and readability scores and correlations between readability instruments.

RESULTS

Of the 82 websites, 93% were of private clinic/hospital, 6% were of non-profit organisation and 1% were of government. None of the 82 websites were HON certification, and the mean score of the item determining the general quality measure in DISCERN was 1.83 in a five-point scale. The mean of Ateşman readability formula value was calculated as 50.46 (±8.16). This value is defined as 'moderately hard' according to the readability scale. The average of Bezirci-Yılmaz new readability formula value is 13.85 (±3.48). This value is defined as 13th and 14th grade.

CONCLUSIONS

The quality of Internet-based health information about the voice is generally inadequate, and the sites examined in this study may be limited due to high readability levels. This may be a problem in people with poor literacy skills. For this reason, it is very important for speech and language therapists and other health professionals to evaluate and monitor the quality and readability of Internet-based information.

Navigating online health information: Insights into consumer influence and decision-making strategies-An overview of reviews

Objective

Communities' use of technology and the internet for online health information (OHI) is increasing exponentially. An understanding of how and why individuals access OHI, and how this information influences decisions on health, medicines and self-care practices is critical. This review aims to: (1) identify the factors influencing OHI-seeking behaviour; (2) evaluate the evidence of OHI on self-care practices; and (3) outline strategies to improve online informed decision-making and assess the impact of these strategies on consumer outcomes.

Methods

A review of systematic reviews was conducted in November of 2023, following the Cochrane Handbook and PRISMA guidelines, and using PubMed, Scopus, Web of Science and EBSCOhost databases. The methodological quality of retrieved reviews was appraised using the AMSTAR 2 tool.

Results

The search retrieved 1725 records. Of these, 943 were screened, and 33 were included in the final analysis. The most frequently identified reasons for seeking OHI were to retrieve diagnostic and treatment information, and well-being and emotional support. Level of education and socio-economic status influenced OHI-seeking. OHI directly influenced self-care decision-making by individuals and their relationships and communication with healthcare providers. Overall, OHI-seeking (and interventions to promote the use of OHI) enhanced individuals' confidence, skills and knowledge.

Conclusions

The findings highlight the benefits of OHI-seeking and its potential influence on self-care decisions. Future research should focus on strategies that would promote the pursuit of high-quality, up-to-date OHI and on the development of interventions for healthcare professionals to improve patients' use of OHI in self-care and self-efficacy.

Online health information behaviour and its association with statin adherence in patients with high cardiovascular risk: A prospective cohort study

Objective

Statins are effective for preventing cardiovascular disease. However, many patients decide not to take statins because of negative influences, such as online misinformation. Online health information may affect decisions on medication adherence, but measuring it is challenging. This study aimed to examine the associations between online health information behaviour and statin adherence in patients with high cardiovascular risk.

Methods

A prospective cohort study involving 233 patients with high cardiovascular risk was conducted at a primary care clinic in Malaysia. Participants used a digital information diary tool to record online health information they encountered for 2 months and completed a questionnaire about statin necessity, concerns and adherence at the end of the observation period. Data were analysed using structural equation modelling.

Results

The results showed that 55.8% (130 of 233 patients) encountered online health information. Patients who actively sought online health information (91 of 233 patients) had higher concerns about statin use (β = 0.323, p = 0.023). Participants with higher concern about statin use were also more likely to be non-adherent (β = -0.337, p < 0.001). Patients who actively sought online health information were more likely to have lower statin adherence, mediated by higher concerns about statin use (indirect effect, β = -0.109, p = 0.048).

Conclusions

Our results suggest that patients with higher levels of concern about statins may be actively seeking online information about statins, and their concerns might influence how they search, what they find, and the potential to encounter misinformation. Our study highlights the importance of addressing patients' concerns about medications to improve adherence.

Experiences and influences of online health information-seeking about statin use in patients with high cardiovascular risk: a qualitative study

OBJECTIVES

Online health information (OHI) has been shown to influence patients' health decisions and behaviours. OHI about statins has created confusion among healthcare professionals and the public. This study explored the views and experiences of patients with high cardiovascular risk on OHI-seeking about statins and how OHI influenced their decision.

DESIGN

This was a qualitative study using semi-structured in-depth interviews. An interpretive description approach with thematic analysis was used for data analysis.

SETTING

An urban primary care clinic in Kuala Lumpur, Malaysia.

PARTICIPANTS

Patients aged 18 years and above who had high cardiovascular risk and sought OHI on statins were recruited.

RESULTS

A total of 20 participants were interviewed. The age of the participants ranged from 38 to 74 years. Twelve (60%) participants took statins for primary cardiovascular disease prevention. The duration of statin use ranged from 2 weeks to 30 years. Six themes emerged from the data analysis: (i) seeking OHI throughout the disease trajectory, (ii) active and passive approaches to seeking OHI, (iii) types of OHI, (iv) views about statin-related OHI, (v) influence of OHI on patients' health decisions, and (vi) patient-doctor communication about OHI.

CONCLUSION

This study highlights the changing information needs throughout patient journeys, suggesting the opportunity to provide needs-oriented OHI to patients. Unintentional passive exposure to OHI appears to have an influence on patients' adherence to statins. The quality of patient-doctor communication in relation to OHI-seeking behaviour remains a critical factor in patient decision-making.

How do patients with high cardiovascular risk evaluate online health information? A qualitative study

BACKGROUND

People are exposed to variable health information from the Internet, potentially influencing their health decision-making and behaviour. It remains a challenge for people to discern between good- and poor-quality online health information (OHI). This study explored how patients evaluate and determine trust in statin-related OHI in patients with high cardiovascular risk.

METHODS

This qualitative study used vignettes and think-aloud methods. We recruited patients from a primary care clinic who were at least 18 years old, had high cardiovascular risk and had previously sought OHI. Participants were given two statin-related vignettes: Vignette 1 (low-quality information) and Vignette 2 (high-quality information). Participants voiced their thoughts aloud when reading the vignettes and determined the trust level for each vignette using a 5-point Likert scale. This was followed by a semi-structured interview which was audio-recorded and transcribed verbatim. The transcripts were coded and analysed using thematic analysis.

RESULTS

A total of 20 participants were recruited, with age ranging from 38-74 years. Among all the high cardiovascular-risk participants, eight had pre-existing cardiovascular diseases. For Vignette 1 (low-quality information), five participants trusted it while nine participants were unsure of their trust. 17 participants (85%) trusted Vignette 2 (high-quality information). Five themes emerged from the analysis of how patients evaluated OHI: (1) logical content, (2) neutral stance and tone of OHI content, (3) credibility of the information source, (4) consistent with prior knowledge and experience, and (5) corroboration with information from other sources.

CONCLUSION

Patients with high cardiovascular risks focused on the content, source credibility and information consistency when evaluating and determining their trust in statin-related OHI. Doctors should adopt a more personalised approach when discussing statin-related online misinformation with patients by considering their prior knowledge, beliefs and experience of statin use.

Predicting and Empowering Health for Generation Z by Comparing Health Information Seeking and Digital Health Literacy: Cross-Sectional Questionnaire Study

BACKGROUND

Generation Z (born 1995-2010) members are digital residents who use technology and the internet more frequently than any previous generation to learn about their health. They are increasingly moving away from conventional methods of seeking health information as technology advances quickly and becomes more widely available, resulting in a more digitalized health care system. Similar to all groups, Generation Z has specific health care requirements and preferences, and their use of technology influences how they look for health information. However, they have often been overlooked in scholarly research.

OBJECTIVE

First, we aimed to identify the information-seeking preferences of older individuals and Generation Z (those between the ages of 18 and 26 years); second, we aimed to predict the effects of digital health literacy and health empowerment in both groups. We also aimed to identify factors that impact how both groups engage in digital health and remain in control of their own health.

METHODS

The Health Information National Trends Survey was adopted for further use in 2022. We analyzed 1862 valid data points by conducting a survey among Chinese respondents to address the research gap. A descriptive analysis, 2-tailed t test, and multiple linear regression were applied to the results.

RESULTS

When compared with previous generations, Generation Z respondents (995/1862, 53.44%) were more likely to use the internet to find out about health-related topics, whereas earlier generations relied more on traditional media and interpersonal contact. Web-based information-seeking behavior is predicted by digital health literacy (Generation Z: β=.192, P<.001; older population: β=.337, P<.001). While this was happening, only seeking health information from physicians positively predicted health empowerment (Generation Z: β=.070, P=.002; older population: β=.089, P<.001). Despite more frequent use of the internet to learn about their health, Generation Z showed lower levels of health empowerment and less desire to look for health information, overall.

CONCLUSIONS

This study examined and compared the health information-seeking behaviors of Generation Z and older individuals to improve their digital health literacy and health empowerment. The 2 groups demonstrated distinct preferences regarding their choice of information sources. Health empowerment and digital health literacy were both significantly related to information-seeking behaviors.

How socioeconomically disadvantaged people access, understand, appraise, and apply health information: A qualitative study exploring health literacy skills

OBJECTIVES

Health literacy, or a person's competence to access, understand, appraise and apply health information, can be considered a mediating factor between socioeconomic characteristics and health disparities. Socioeconomically disadvantaged people in particular present with less health literacy skills. To develop targeted interventions tailored to their real needs, it is important to understand how they function and what difficulties they encounter when dealing with health information. The purpose of this study was to explore their experiences when accessing, understanding, appraising, and applying health information in their everyday lives.

METHODS

Semi-structured face-to-face interviews were conducted with 12 socioeconomically disadvantaged adults living in the community in Switzerland (age range: 44-60 years old).

RESULTS

Thematic analysis of the interviews yielded four themes, describing the health literacy processes of participants, related barriers, and compensatory strategies used: Financial insecurity triggers the need for health information; Pathway 1: Physicians as ideal (but expensive) interlocutors; Pathway 2: The internet as a suboptimal alternative; and Pathway 3: Relatives as a default resource. The progression of socioeconomically disadvantaged people in the health literacy process is like an 'obstacle course', with numerous steps taken backwards before they can develop compensatory strategies to overcome the barriers to obtaining health information.

CONCLUSIONS

Financial deprivation seems to be the most important factor contributing to health literacy barriers. Appraising health information is the health literacy skill with which socioeconomically disadvantaged people struggle the most. Physician-based, individual skills-based, organizational, and policy-based interventions are needed to help them overcome their health literacy challenges.

Explainable online health information truthfulness in Consumer Health Search

Introduction

People are today increasingly relying on health information they find online to make decisions that may impact both their physical and mental wellbeing. Therefore, there is a growing need for systems that can assess the truthfulness of such health information. Most of the current literature solutions use machine learning or knowledge-based approaches treating the problem as a binary classification task, discriminating between correct information and misinformation. Such solutions present several problems with regard to user decision making, among which: (i) the binary classification task provides users with just two predetermined possibilities with respect to the truthfulness of the information, which users should take for granted; indeed, (ii) the processes by which the results were obtained are often opaque and the results themselves have little or no interpretation.

Methods

To address these issues, we approach the problem as an ad hoc retrieval task rather than a classification task, with reference, in particular, to the Consumer Health Search task. To do this, a previously proposed Information Retrieval model, which considers information truthfulness as a dimension of relevance, is used to obtain a ranked list of both topically-relevant and truthful documents. The novelty of this work concerns the extension of such a model with a solution for the explainability of the results obtained, by relying on a knowledge base consisting of scientific evidence in the form of medical journal articles.

Results and discussion

We evaluate the proposed solution both quantitatively, as a standard classification task, and qualitatively, through a user study to examine the "explained" ranked list of documents. The results obtained illustrate the solution's effectiveness and usefulness in making the retrieved results more interpretable by Consumer Health Searchers, both with respect to topical relevance and truthfulness.

International differences and inaccuracies in the public advertising about calcaneal apophysitis: an audit of websites originating in Australia, UK and USA

BACKGROUND

Calcaneal apophysitis is a common condition in childhood. Parents often seek online information for children's' health care concerns prior to seeking care. Therefore, we aimed to evaluate the credibility, readability, and accuracy of calcaneal apophysitis advertising on popular websites in three countries.

METHODS

We used content analysis of publicly accessible data. This involved identifying the top 50 websites in each country from their hit rates. We used elements of validated tools to audit and determine frequencies relevant to credibility (e.g. publisher), readability (e.g. literacy score) and accuracy (e.g. alignment with evidence). Data were analysed quantitatively and reported against each element.

RESULTS

Websites were predominantly hosted by private health services (n = 118, 79%). The mean (SD) SMOG (readability) score was 9.3 (4.5). The majority of websites (n = 140, 93%) provided at least one treatment recommendation, and less than 10% (n = 11) of websites advertised treatments fully aligned with evidence. Use of treatment modalities without evidence and with high risk to children were also found including surgery, extracorporeal shock wave therapy and laser.

CONCLUSIONS

Calcaneal apophysitis online advertising is mostly curated by clinicians. Clinicians should consider revising online advertising to increase understandability and accuracy to reduce health care wastage, risk, and low value care.

Utility and usability evaluation of an information diary tool to measure health information access and exposure among patients with high cardiovascular risk

Background

Online health misinformation about statins potentially affects health decision-making on statin use and adherence. We developed an information diary platform (IDP) to measure topic-specific health information exposure where participants record what information they encounter. We evaluated the utility and usability of the smartphone diary from the participants' perspective.

Methods

We used a mixed-method design to evaluate how participants used the smartphone diary tool and their perspectives on usability. Participants were high cardiovascular-risk patients recruited from a primary care clinic and used the tool for a week. We measured usability with the System Usability Scale (SUS) questionnaire and interviewed participants to explore utility and usability issues.

Results

The information diary was available in three languages and tested with 24 participants. The mean SUS score was 69.8 ± 12.9. Five themes related to utility were: IDP functions as a health information diary; supporting discussion of health information with doctors; wanting a feedback function about credible information; increasing awareness of the need to appraise information; and wanting to compare levels of trust with other participants or experts. Four themes related to usability were: ease of learning and use; confusion about selecting the category of information source; capturing offline information by uploading photos; and recording their level of trust.

Conclusion

We found that the smartphone diary can be used as a research instrument to record relevant examples of information exposure. It potentially modifies how people seek and appraise topic-specific health information.

Readability, Content, and Accountability Assessment of Online Health Information for Retinitis Pigmentosa & Retinitis Pigmentosa Treatment Options

PURPOSE

New therapies for retinitis pigmentosa (RP) have led to patients desiring more information about their disease. We assessed the readability, content, and accountability of online health information for RP and its treatments.

METHODS

Two internet queries were performed: one pertaining to the condition RP, and another pertaining to treatments of RP. Three analyses were performed on the top search results that met eligibility criteria: (1) A readability analysis produced an average reading level; (2) A content analysis was conducted to score each source on the accuracy, completeness, clarity, and organization of the content; and (3) An accountability analysis was performed to evaluate adherence to accountability benchmarks, including authorship, attribution, disclosure, and currency.

RESULTS

The mean reading level was 12.0 (SD = 3.2, 95% CI = 11.0-13.0) for the 8 RP webpages and 12.5 (SD = 3.1, 95% CI = 11.7-13.4) for the 10 RP treatment webpages. The mean content score for RP sites was 21.3 of 32 points (SD = 4.1, 95% CI = 19.5-23.0). The mean content score for RP treatment sites was 5.5 out of 16 points (SD = 3.7, 95% CI = 4.1-6.9). The inter-rater reliability was 0.973 (Cronbach's alpha). For RP sites, the mean accountability score was 2.6 out of 4 points (SD = 0.9, 95% CI = 1.9-3.4). For RP treatment sites, the mean accountability score was 2 out of 4 points (SD = 0.9, 95% CI = 1.4-2.6).

CONCLUSION

Our data suggest that the online information available to patients regarding RP and RP treatment options exceeds the AMA-recommended sixth-grade reading level and contains gaps in content relevant to patients.

Dr. Google: Physicians-The Web-Patients Triangle: Digital Skills and Attitudes towards e-Health Solutions among Physicians in South Eastern Poland-A Cross-Sectional Study in a Pre-COVID-19 Era

The investment in digital e-health services is a priority direction in the development of global healthcare systems. While people are increasingly using the Web for health information, it is not entirely clear what physicians' attitudes are towards digital transformation, as well as the acceptance of new technologies in healthcare. The aim of this cross-sectional survey study was to investigate physicians' self-digital skills and their opinions on obtaining online health knowledge by patients, as well as the recognition of physicians' attitudes towards e-health solutions. Principal component analysis (PCA) was performed to emerge the variables from self-designed questionnaire and cross-sectional analysis, comparing descriptive statistics and correlations for dependent variables using the one-way ANOVA (F-test). A total of 307 physicians participated in the study, reported as using the internet mainly several times a day (66.8%). Most participants (70.4%) were familiar with new technologies and rated their e-health literacy high, although 84.0% reported the need for additional training in this field and reported a need to introduce a larger number of subjects shaping digital skills (75.9%). 53.4% of physicians perceived Internet-sourced information as sometimes reliable and, in general, assessed the effects of its use by their patients negatively (41.7%). Digital skills increased significantly with frequency of internet use (F = 13.167; p = 0.0001) and decreased with physicians' age and the need for training. Those who claimed that patients often experienced health benefits from online health showed higher digital skills (-1.06). Physicians most often recommended their patients to obtain laboratory test results online (32.2%) and to arrange medical appointments via the Internet (27.0%). Along with the deterioration of physicians' digital skills, the recommendation of e-health solutions decreased (r = 0.413) and lowered the assessment of e-health solutions for the patient (r = 0.449). Physicians perceive digitization as a sign of the times and frequently use its tools in daily practice. The evaluation of Dr. Google's phenomenon and online health is directly related to their own e-health literacy skills, but there is still a need for practical training to deal with the digital revolution.

Predicting Fact-Checking Health Information Before Sharing Among People with Different Levels of Altruism: Based on the Influence of Presumed Media Influence

Background

Pervasive health misinformation on social media affects people's health. Fact-checking health information before it is shared is an altruistic behavior that effectively addresses health misinformation on social media.

Purpose

Based on the influence of presumed media influence (IPMI), this study serves two purposes: The first is to investigate factors that influence social media users' decisions to fact-check health information before sharing it in accordance with the IPMI model. The second is to explore different predictive powers of the IPMI model for individuals with different levels of altruism.

Methods

This study conducted a questionnaire survey of 1045 Chinese adults. Participants were divided into either a low-altruism group (n = 545) or a high-altruism group (n = 500) at the median value of altruism. A multigroup analysis was conducted with R Lavaan package (Version 0.6-15).

Results

All of the hypotheses were supported, which confirms the applicability of the IPMI model in the context of fact-checking health information on social media before sharing. Notably, the IPMI model yielded different results for the low- and high-altruism groups.

Conclusion

This study confirmed the IPMI model can be employed in the context of fact-checking health information. Paying attention to health misinformation can indirectly affect an individual's intention to fact-check health information before they share it on social media. Furthermore, this study demonstrated the IPMI model's varying predictive powers for individuals with different altruism levels and recommended specific strategies health-promotion officials can take to encourage others to fact-check health information.

Pharmacist-Involved Antiretroviral Stewardship Programs in People Living with HIV/AIDS: A Systematic Review

People living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS; PLWHA) frequently encounter antiretroviral (ARV) therapy-related problems. Clinical pharmacists with specialized training in ARV stewardship play an important role in managing these problems. However, there is a paucity of evidence to clarify the impact of clinical pharmacists' interventions on managing ARV therapy-related problems in PLWHA. Therefore, we aim to systematically review the literature to determine the nature and impact of pharmacists' interventions on managing medication-related problems in PLWHA. The review protocol was registered on International Prospective Register of Systematic Reviews (PROSPERO; CRD42020173078). Relevant records were identified from six electronic bibliographic databases (PubMed, Embase, EBSCOhost, ProQuest, Scopus, and the Cochrane Central Register) from their inception until September 2022. We included all randomized and nonrandomized interventional studies that were published in English. After the abstract and full-text screening, data were extracted from the selected studies, and the quality of the studies was assessed. The electronic database search and citation tracking identified two thousand and three citations. The review included 21 of these studies, involving 2998 PLWHA, published between 2014 and 2022. Pharmacists' interventions, working alone or in a multi-disciplinary team, comprised ARV medication review, management of adverse drug reactions (ADRs), therapeutic drug monitoring, prevention of drug interactions, and provision of drug information to PLWHA or the health care team. The pharmacist-involved interventions significantly reduced incorrect/incomplete ARV regimens, drug interactions, incorrect dosages, duplicate therapy, polypharmacy, administration errors, missing medication, wrong formulation, ADRs, and prescribing errors. Most studies reported that physicians usually accept more than 90% of the pharmacists' recommendations. ARV medication-related problems remain highly prevalent in PLWHA. Pharmacist-led interventions and stewardship significantly reduce ARV therapy-related problems in PLWHA and are widely accepted by physicians. Dedicated pharmacists with specialized training and credentialing in infectious diseases or HIV/AIDS have a great potential to improve health outcomes in PLWHA.

Impact of health-related internet use on disease management behavior of chronic patients: Mediating role of perceived credibility of online information

During the last two decades, Internet use has increased in all parts of the world. Although, the trend of actively using the Internet for seeking health-related information was already on the rise, it accelerated soon after the COVID-19 pandemic. Along with the increased use of the Internet for health decisions, serious concerns have been raised due to fake or misinformation. This study aims to determine the impact of Internet use for gathering health-related information on the disease management behavior of patients and to identify the mediating role of perceived credibility of online information. The study surveyed 200 chronic disease patients with diabetes and hypertension from the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. It is concluded that overall health-related Internet use has a positive impact on the disease management behavior of chronic disease patients. The study further confirms the mediating role of the perceived credibility of online information. Patients who are frequent users of the Internet for health information, who perceive online information more credible, reported better disease management behavior as compared to the less frequent users and those who perceive online information less credible.

Quality of Late-Life Depression Information on the Internet: Website Evaluation Study

BACKGROUND

The internet can increase the accessibility of mental health information and improve the mental health literacy of older adults. The quality of mental health information on the internet can be inaccurate or biased, leading to misinformation.

OBJECTIVE

This study aims to evaluate the quality, usability, and readability of websites providing information concerning depression in later life.

METHODS

Websites were identified through a Google search and evaluated by assessing quality (DISCERN), usability (Patient Education Materials Assessment Tool), and readability (Simple Measure of Gobbledygook).

RESULTS

The overall quality of late-life depression websites (N=19) was adequate, and the usability and readability were poor. No significant relationship was found between the quality and readability of the websites.

CONCLUSIONS

The websites can be improved by enhancing information quality, usability, and readability related to late-life depression. The use of high-quality websites may improve mental health literacy and shared treatment decision-making for older adults.

Laypeople's Online Health Information Search Strategies and Use for Health-Related Problems: Cross-sectional Survey

Background

With the increase in the use of the internet to search for health information about health-related problems, there is a need for health care professionals to better understand how their patients search for and use the online health information that may influence their medical decision making.

Objective

The aims of this study are to explore laypeople’s online health information search strategies and examine the relationships between their search strategies and utilization behavior of online health information.

Methods

Two scales, namely match and elaboration, were used to measure patients’ basic search strategies (ie, simple approach) and advanced search strategies (ie, integrative approach), respectively. In addition, the consultation scale was used to evaluate the participants’ use of online health information to consult doctors and others. A total of 253 outpatients without university education were purposely selected and surveyed. The participants were outpatients at a university-affiliated teaching hospital. Partial least squares-structural equation modeling (PLS-SEM) was performed to analyze the measurement model to specify the measurement validation. In addition, the structure model of PLS-SEM was evaluated to examine the path correlations between variables and to execute interaction effect and curvilinear relationship analyses.

Results

The results of the path correlation analysis by PLS-SEM showed that both elaboration strategy (path coefficient=0.55, P<.001) and match strategy (path coefficient=0.36, P<.001) were positively correlated with consultation on online health information with doctors and others. In addition, interaction effect and curvilinear relationship analyses indicated that there was a significant interaction effect between elaboration and match on consultation (path coefficient=–0.34, P<.001) and a significant curvilinear relationship between match and consultation (path coefficient=–0.09, P=.046).

Conclusions

Increasing patients’ exposure to online health information through both a simple search approach (ie, match strategy) and a complex search approach (ie, elaboration strategy) may lead them to appropriately use the information to consult doctors and others. However, the results of interaction effect and curvilinear relationship analyses highlighted the essential role of the elaboration strategy to properly locate, evaluate, and apply online health information. The findings of this study may help health care professionals better understand how to communicate with their patients through the health information on the internet.

Superlatives, clickbaits, appeals to authority, poor grammar, or boldface: Is editorial style related to the credibility of online health messages?

Adolescents, as active online searchers, have easy access to health information. Much health information they encounter online is of poor quality and even contains potentially harmful health information. The ability to identify the quality of health messages disseminated via online technologies is needed in terms of health attitudes and behaviors. This study aims to understand how different ways of editing health-related messages affect their credibility among adolescents and what impact this may have on the content or format of health information. The sample consisted of 300 secondary school students (M_age = 17.26; SD_age = 1.04; 66.3% female). To examine the effects of manipulating editorial elements, we used seven short messages about the health-promoting effects of different fruits and vegetables. Participants were then asked to rate the message’s trustworthiness with a single question. We calculated second-order variable sensitivity as the derivative of the trustworthiness of a fake message from the trustworthiness of a true neutral message. We also controlled for participants’ scientific reasoning, cognitive reflection, and media literacy. Adolescents were able to distinguish overtly fake health messages from true health messages. True messages with and without editorial elements were perceived as equally trustworthy, except for news with clickbait headlines, which were less trustworthy than other true messages. The results were also the same when scientific reasoning, analytical reasoning, and media literacy were considered. Adolescents should be well trained to recognize online health messages with editorial elements characteristic of low-quality content. They should also be trained on how to evaluate these messages.

Contexts and Outcomes of Proxy Online Health Information Seeking: Mixed Studies Review With Framework Synthesis

Background

High-quality online health information (OHI) can reduce unnecessary visits to health professionals and improve health. One of the ways that people use OHI is to support others with health conditions through proxy OHI seeking. Members of a person’s social circle may help them overcome information-seeking barriers and illness challenges. There are several models on proxy information seeking. Yet, we know little about the use and outcomes of OHI on behalf of someone else.

Objective

The objectives of this paper are to explore and revise a framework on the context and outcomes of proxy OHI seeking

Methods

We conducted a mixed studies literature review integrating qualitative and quantitative evidence with thematic analysis of the findings of 28 studies, followed by framework synthesis incorporating the derived themes.

Results

We explored 4 main themes: (1) characteristics of proxy seekers, (2) context of proxy OHI seeking, (3) use of OHI to provide social support, and (4) outcomes of proxy OHI seeking. Our conceptual framework incorporates these themes and builds on previous work.

Conclusions

By better understanding how people use information together, information providers can adapt the information to meet all users’ needs.

COVID-19 Vaccination and Intent Among Pregnant Women, United States, April 2021

Objectives:

National data on COVID-19 vaccination coverage among pregnant women are limited. We assessed COVID-19 vaccination coverage and intent, factors associated with COVID-19 vaccination, reasons for nonvaccination, and knowledge, attitudes, and beliefs related to COVID-19 illness and vaccination among pregnant women in the United States.

Methods:

Data from an opt-in internet panel survey of pregnant women conducted March 31–April 16, 2021, assessed receipt of ≥1 dose of any COVID-19 vaccine during pregnancy. The sample included 1516 women pregnant any time during December 1, 2020–April 16, 2021, who were not fully vaccinated before pregnancy. We used multivariable logistic regression to determine variables independently associated with receipt of COVID-19 vaccine.

Results:

As of April 16, 2021, 21.7% of pregnant women had received ≥1 dose of COVID-19 vaccine during pregnancy, 24.0% intended to receive a vaccine, 17.2% were unsure, and 37.1% did not intend to receive a vaccine. Pregnant women with (vs without) a health care provider recommendation (adjusted prevalence ratio [aPR] = 4.86), those who lived (vs not) with someone with a condition that could increase risk for serious medical complications of COVID-19 (aPR = 2.11), and those who had received (vs not) an influenza vaccination (aPR = 2.35) were more likely to receive a COVID-19 vaccine. Common reasons for nonvaccination included concerns about safety risk to baby (37.2%) or self (34.6%) and about rapid vaccine development (29.7%) and approval (30.9%).

Conclusions:

Our findings indicate a continued need to emphasize the benefits of COVID-19 vaccination during pregnancy and to widely disseminate the recommendations of the Centers for Disease Control and Prevention and other clinical professional societies for all pregnant women to be vaccinated.

A comparative study of strategies for identifying credible sources of mental health information online: Can clinical services deliver a youth-specific internet prescription?

BACKGROUND

Adolescents and young adults undertake internet searches before and after attending mental health consultations, but they express concerns about how they can identify reliable online mental health information (OMHI). This action research project examines how clinicians might direct young people towards credible OMHI by analysing which search strategies are most helpful for developing an 'internet prescription' targeted at a youth audience.

METHODS

Recently qualified doctors undertook searches for OMHI about the diagnosis and treatment of seven mental health conditions. Rankings of websites in search results were compared with reliability and quality ratings derived from established evaluation instruments [the Brief DISCERN and the 12-item Health on the Net (HoN) tool].

RESULTS

Of 140 websites identified through seven Google searches, only 15% of those evaluated were categorized as high quality. About 17% of websites were selling a treatment or service and about 25% were regarded as untrustworthy. Also, higher rankings in the search results were not indicative of better quality OMHI (Wilcoxon signed rank test: Z = -5.28; p < .001). Although the HoN and DISCERN tools provided useful insights into the credibility of OMHI, investigators did not think either instrument could be recommended for independent use by youth.

CONCLUSIONS

Our findings suggest that clinical services should take responsibility for identifying a range of credible sources of OMHI. The next step in translating the research strategy into clinical practice involves collaboration with young people to select those platforms most orientated to their needs and to develop rating instruments that enable youth to evaluate OMHI.

COVID-19 Vaccination and Intent Among Healthcare Personnel, U.S

INTRODUCTION

Healthcare personnel are at increased risk for COVID-19 from workplace exposure. National estimates on COVID-19 vaccination coverage among healthcare personnel are limited.

METHODS

Data from an opt-in Internet panel survey of 2,434 healthcare personnel, conducted on March 30, 2021-April 15, 2021, were analyzed to assess the receipt of ≥1 dose of a COVID-19 vaccine and vaccination intent. Multivariable logistic regression was used to assess the factors associated with COVID-19 vaccination and intent for vaccination.

RESULTS

Overall, 68.2% of healthcare personnel reported a receipt of ≥1 dose of a COVID-19 vaccine, 9.8% would probably/definitely get vaccinated, 7.1% were unsure, and 14.9% would probably/definitely not get vaccinated. COVID-19 vaccination coverage was highest among physicians (89.0%), healthcare personnel working in hospitals (75.0%), and healthcare personnel of non-Hispanic White or other race (75.7%-77.4%). Healthcare personnel who received influenza vaccine in 2020-2021 (adjusted prevalence ratio=1.92) and those aged ≥60 years (adjusted prevalence ratio=1.37) were more likely to report a receipt of ≥1 dose of a COVID-19 vaccine. Non-Hispanic Black healthcare personnel (adjusted prevalence ratio=0.74), nurse practitioners/physician assistants (adjusted prevalence ratio=0.55), assistants/aides (adjusted prevalence ratio=0.73), and nonclinical healthcare personnel (adjusted prevalence ratio=0.79) were less likely to have received a COVID-19 vaccine. The common reasons for vaccination included protecting self (88.1%), family and friends (86.3%), and patients (69.2%) from COVID-19. The most common reason for nonvaccination was concern about side effects and safety of COVID-19 vaccine (59.7%).

CONCLUSIONS

Understanding vaccination status and intent among healthcare personnel is important for addressing barriers to vaccination. Addressing concerns on side effects, safety, and effectiveness of COVID-19 vaccines as well as their fast development and approval may help improve vaccination coverage among healthcare personnel.

Research to Clinical Practice-Youth seeking mental health information online and its impact on the first steps in the patient journey

BACKGROUND

Online searches about anxiety and depression are recorded every 3-5 s. As such, information and communication technologies (ICT) have enormous potential to enable or impair help-seeking and patient-professional interactions. Youth studies indicate that ICT searches are undertaken before initial mental health consultations, but no publications have considered how this online activity affects the first steps of the patient journey in youth mental health settings.

METHODS

State-of-the-art review using an iterative, evidence mapping approach to identify key literature and expert consensus to synthesize and prioritise clinical and research issues.

RESULTS

Adolescents and young adults are more likely to seek health advice via online search engines or social media platforms than from a health professional. Young people not only search user-generated content and social media to obtain advice and support from online communities but increasingly contribute personal information online.

CONCLUSIONS

A major clinical challenge is to raise professional awareness of the likely impact of this activity on mental health consultations. Potential strategies range from modifying the structure of clinical consultations to ensure young people are able to disclose ICT activities related to mental health, through to the development and implementation of 'internet prescriptions' and a youth-focused 'toolkit'.