Anxiety increases information-seeking in response to large changes

Relating caregiver experiences to personalized "push" content in mobile applications among caregivers of pediatric patients with oncology conditions

OBJECTIVE

With the evolution of data algorithms and personalized push systems in mobile applications, patients who have searched for disease-related information may repeatedly receive similar content on app homepages or through notifications. This study aims to assess the influence of health-related content delivered through mobile applications on the anxiety and depression levels of caregivers of pediatric oncology patients.

METHODS

A survey consisting of 16 questions was conducted among 91 caregivers of pediatric oncology patients at the Children's Hospital affiliated with Chongqing Medical University. The questionnaire was designed by oncologists and the Hospital Anxiety and Depression Scale was used to assess the caregivers' psychological states.

RESULTS

The study found that 31.5% of caregivers exhibited borderline anxiety symptoms, while 20.2% displayed borderline depression symptoms. Caregivers who noticed changes in homepage recommendations reported higher levels of anxiety (p = .004) and depression (p = .034). Additionally, 50.6% occasionally felt anxious or uneasy due to personalized notifications and 19.1% frequently felt this way. Moreover, 53.9% of the caregivers reported a negative impact on their emotions or daily life.

SIGNIFICANCE

Personalized push notifications related to disease information in mobile applications can impose a significant psychological burden on patients and their caregivers. Mobile application developers and healthcare providers must strengthen their support in the digital health domain to enhance the emotional well-being of cancer patients and their caregivers.

Information search under uncertainty across transdiagnostic psychopathology and healthy ageing

When making decisions in everyday life, we often rely on an internally generated sense of confidence to help us revise and direct future behaviours. For instance, confidence directly informs whether further information should be sought prior to commitment to a final decision. Many studies have shown that aging and both clinical and sub-clinical symptoms of psychopathology are associated with systematic alterations in confidence. However, it remains unknown whether these confidence distortions influence information-seeking behaviour. We investigated this question in a large general population sample (N = 908). Participants completed a battery of psychiatric symptom questionnaires and performed a perceptual decision-making task with confidence ratings in which they were offered the option to seek helpful information (at a cost) before committing to a final decision. Replicating previous findings, an 'anxious-depression' (AD) symptom dimension was associated with systematically low confidence, despite no detriment in objective task accuracy. Conversely, a 'compulsive behaviour and intrusive thoughts' (CIT) dimension was associated with impaired task accuracy but paradoxical over-confidence. However, neither symptom dimension was significantly associated with an increased or decreased tendency to seek information. Hence, participants scoring highly for AD or CIT did not use the option to information seek any more than average to either increase their confidence (AD) or improve the accuracy of their decisions (CIT). In contrast, older age was associated with impaired accuracy and decreased confidence initially, but increased information seeking behaviour mediated increases in both accuracy and confidence for final decisions. Hence, older adults used the information seeking option to overcome initial deficits in objective performance and to increase their confidence accordingly. The results show an appropriate use of information seeking to overcome perceptual deficits and low confidence in healthy aging which was not present in transdiagnostic psychopathology.

Anti-establishment sentiments: realistic and symbolic threat appraisals predict populist attitudes and conspiracy mentality

Previous research has found that populist attitudes and conspiracy mentality - here summarised as anti-establishment attitudes - increase when people feel threatened. Two types of intergroup threat have been distinguished, namely realistic threats (pertaining to socio-economic resources, climate, or health), and symbolic threats (pertaining to cultural values). However, there is no agreement on which types of threat and corresponding appraisals would be most important in predicting anti-establishment attitudes. We hypothesise that it is the threat itself, irrespective of its cause, that predicts anti-establishment attitudes. In the current paper, we conducted new (multilevel) regression analyses on previously collected data from four high-powered studies with multiple time points (Study 1) or collected in multiple nations (Studies 2-4). All studies included a populist attitudes scale, a conspiracy mentality scale, and different types of threat and emotion measures, reflecting both realistic and symbolic threats. Across studies, both realistic and symbolic threats positively predicted anti-establishment attitudes. The results support an emotional appraisal approach to anti-establishment attitudes, which highlights the importance of anxiety and feeling threatened regardless of what type of event elicits the threat.

Heterogeneity in strategy use during arbitration between experiential and observational learning

To navigate our complex social world, it is crucial to deploy multiple learning strategies, such as learning from directly experiencing action outcomes or from observing other people's behavior. Despite the prevalence of experiential and observational learning in humans and other social animals, it remains unclear how people favor one strategy over the other depending on the environment, and how individuals vary in their strategy use. Here, we describe an arbitration mechanism in which the prediction errors associated with each learning strategy influence their weight over behavior. We designed an online behavioral task to test our computational model, and found that while a substantial proportion of participants relied on the proposed arbitration mechanism, there was some meaningful heterogeneity in how people solved this task. Four other groups were identified: those who used a fixed mixture between the two strategies, those who relied on a single strategy and non-learners with irrelevant strategies. Furthermore, groups were found to differ on key behavioral signatures, and on transdiagnostic symptom dimensions, in particular autism traits and anxiety. Together, these results demonstrate how large heterogeneous datasets and computational methods can be leveraged to better characterize individual differences.

Understanding the Impact of Communicating Uncertainty About COVID-19 in the News: Randomized Between-Subjects Factorial Experiment

BACKGROUND

Whether and how the uncertainty about a public health crisis should be communicated to the general public have been important and yet unanswered questions arising over the past few years. As the most threatening contemporary public health crisis, the COVID-19 pandemic has renewed interest in these unresolved issues by both academic scholars and public health practitioners.

OBJECTIVE

The aim of this study was to investigate the impact of communicating uncertainty about COVID-19-related threats and solutions on individuals' risk perceptions and misinformation vulnerability, as well as the sequential impact of these effects on health information processing and preventative behavioral intentions.

METHODS

A 2×2 (threat uncertainty [presence vs absence]×solution uncertainty [presence vs absence]) full-fractional between-subjects online experiment was conducted with 371 Chinese adults. Focusing on the discussion of whether the asymptomatic cases detected during the COVID-19 pandemic would further lead to an uncontrolled pandemic, news articles were manipulated in terms of whether the infectiousness of asymptomatic cases and the means to control the transmission are presented in terms of their certainty or uncertainty. Participants were randomly assigned to one of the four experimental conditions, being instructed to read one news article. After reading the news article assigned, participants were asked to respond to a series of questions to assess their cognitive and behavioral responses.

RESULTS

Individuals were more susceptible to believing false COVID-19-related information when a certain threat and uncertain solution were framed in the news article. Moreover, individuals' perceptions of crisis severity increased when exposed to news information containing uncertain solutions. Both misinformation vulnerability and perceived severity were positively associated with information processing. Information seeking was positively associated with protective behavioral intention, whereas information avoidance was negatively associated with protective behavioral intention.

CONCLUSIONS

Our findings imply that uncertainty, depending on its aspect, can be effectively communicated to the public during an emerging public health crisis. These results have theoretical and practical implications for health communicators and journalists. Given its limited influence on individuals' cognitive and behavioral responses, uncertainty related to a health threat should be disseminated to meet the public's expectation of information transparency. However, caution is advised when communicating uncertainty related to potential solutions, as this factor exhibited a mixed impact on individual responses during a crisis.

Large environmental changes reduce valence-dependent belief updating

When updating beliefs, humans tend to integrate more desirable information than undesirable information. In stable environments (low uncertainty and high predictability), this asymmetry favors motivation towards action and perceived self-efficacy. However, in changing environments (high uncertainty and low predictability), this process can lead to risk underestimation and increase unwanted costs. Here, we examine how people (n = 388) integrate threatening information during an abrupt environmental change (mandatory quarantine during the COVID-19 pandemic). Given that anxiety levels are associated with the magnitude of the updating belief asymmetry; we explore its relationship during this particular context. We report a significant reduction in asymmetrical belief updating during a large environmental change as individuals integrated desirable and undesirable information to the same extent. Moreover, this result was supported by computational modeling of the belief update task. However, we found that the reduction in asymmetrical belief updating was not homogeneous among people with different levels of Trait-anxiety. Individuals with higher levels of Trait-anxiety maintained a valence-dependent updating, as it occurs in stable environments. On the other hand, updating behavior was not associated with acute anxiety (State-Anxiety), health concerns (Health-Anxiety), or having positive expectations (Trait-Optimism). These results suggest that highly uncertain environments can generate adaptive changes in information integration. At the same time, it reveals the vulnerabilities of individuals with higher levels of anxiety to adapt the way they learn.

Motivation as a Lens for Understanding Information-seeking Behaviors

Most prior research characterizes information-seeking behaviors as serving utilitarian purposes, such as whether the obtained information can help solve practical problems. However, information-seeking behaviors are sensitive to different contexts (i.e., threat vs. curiosity), despite having equivalent utility. Furthermore, these search behaviors can be modulated by individuals' life history and personality traits. Yet the emphasis on utilitarian utility has precluded the development of a unified model, which explains when and how individuals actively seek information. To account for this variability and flexibility, we propose a unified information-seeking framework that examines information-seeking through the lens of motivation. This unified model accounts for integration across individuals' internal goal states and the salient features of the environment to influence information-seeking behavior. We propose that information-seeking is determined by motivation for information, invigorated either by instrumental utility or hedonic utility, wherein one's personal or environmental context moderates this relationship. Furthermore, we speculate that the final common denominator in guiding information-seeking is the engagement of different neuromodulatory circuits centered on dopaminergic and noradrenergic tone. Our framework provides a unified framework for information-seeking behaviors and generates several testable predictions for future studies.

A neural mechanism for conserved value computations integrating information and rewards

Behavioral and economic theory dictate that we decide between options based on their values. However, humans and animals eagerly seek information about uncertain future rewards, even when this does not provide any objective value. This implies that decisions are made by endowing information with subjective value and integrating it with the value of extrinsic rewards, but the mechanism is unknown. Here, we show that human and monkey value judgements obey strikingly conserved computational principles during multi-attribute decisions trading off information and extrinsic reward. We then identify a neural substrate in a highly conserved ancient structure, the lateral habenula (LHb). LHb neurons signal subjective value, integrating information's value with extrinsic rewards, and the LHb predicts and causally influences ongoing decisions. Neurons in key input areas to the LHb largely signal components of these computations, not integrated value signals. Thus, our data uncover neural mechanisms of conserved computations underlying decisions to seek information about the future.

Public Interest in Psilocybin and Psychedelic Therapy in the Context of the COVID-19 Pandemic: Google Trends Analysis

BACKGROUND

Psychedelic substances have demonstrated promise in the treatment of depression, anxiety, and substance use disorders. Significant media coverage has been dedicated to psychedelic medicine, but it is unclear whether the public associates psilocybin with its potential therapeutic benefits. The COVID-19 pandemic led to an increase in depression, anxiety, and substance abuse in the general population.

OBJECTIVE

This study attempts to link increases in interest in these disorders with increases in interest in psilocybin using Google Trends.

METHODS

Weekly interest-over-time Google Trends data for 4 years, from the week of March 11, 2018, to the week of March 6, 2022, were obtained for the following terms: "psilocybin," "psychedelic therapy," "cannabis," "cocaine," "antidepressant," "depression," "anxiety," and "addiction." Important psilocybin-related news and the declaration of the pandemic were noted. Trends data for each of the queried terms were plotted, and multiple regression analysis was performed to determine the slope of the prepandemic and postpandemic data with 95% CIs. Nonparametric Tau-U analysis was performed correcting for baseline trends. Results from this test were used to make inferences about the pre- and postpandemic trends and inferences about the change in overall level of searches between the 2 groups.

RESULTS

Tau values for prepandemic data were significant for stable trends, all ranging -0.4 to 0.4. Tau values for postpandemic data showed positive trends for "psilocybin," "psychedelic therapy," and "antidepressant." All other trends remained stable in the range of -0.4 to 0.4. When comparing Tau values for pre- and postpandemic data, overall increases in relative search volume (RSV) were seen for "psilocybin," "psychedelic therapy," and "anxiety," and overall decreases in RSV were seen for "depression," "addiction," and "cocaine." Overall RSVs for "cannabis" and "antidepressant" remained stable as Tau values ranged between -0.4 and 0.4. In the immediate aftermath of the declaration of the pandemic, drop-offs in interest were seen for all terms except for "anxiety" and "cannabis." After the initial shock of a global pandemic, "psilocybin" and "psychedelic therapy" groups demonstrated increases in interest trends and overall RSV.

CONCLUSIONS

These data suggest that overall interest in "psilocybin" and "psychedelic therapy" increased at higher rates and to higher levels after than before the declaration of the pandemic. This is consistent with our hypothesis that interest increased for these treatments after the pandemic as incidence of depression, anxiety, and addiction increased. However, there may be other drivers of interest for these topics, since interest in antidepressants-the typical pharmacologic treatments for depression and anxiety-followed the expected pattern of drop-off and accelerated interest back to prepandemic levels. Interest in "psilocybin" and "psychedelic therapy" may have also been partially driven by popular culture hype and novelty, explaining why interest increased at a higher rate post pandemic and continued to grow, surpassing prior interest.

Influence of conflicting prior information on action anticipation in soccer players: an ERP study

Objective

Prior probability information and visual kinematic information are essential for action anticipation in athletes. The aims of this study were to examine how conflicting prior information influences anticipatory judgment in athletes vs. non-athletes and to explore the underlying cognitive mechanisms.

Methods

The aim of Experiment 1 was to determine the moment when prior information influenced action anticipation in athletes vs. non-athletes. To that end, 17 semi-elite soccer goalkeepers and 18 non-athletes received prior information about the probability of the direction that a player on a video would kick a ball into the goal. Participants then anticipated the trajectory of the ball when the action of the player's kick on the video was truncated at the moment the foot contacted the ball (time T) or one frame (T-1; 50 ms) or two frames (T-2; 100 ms) before the foot-ball contact. The aim of Experiment 2 was to elucidate the adaptive cognitive-motor behavior exhibited by highly trained soccer players at the moment when their anticipatory performance was most influenced by prior information. Experiment 2 included 27 different semi-elite soccer players with many years of experience as a goalkeeper and 27 different non-athletes. Participants anticipated the direction of the kick when the kinematic action of the kicker at the moment the anticipatory performance of the participants was most influenced by prior information (as determined in Experiment 1) was congruent, incongruent, or neutral. Action anticipation accuracy and response time were evaluated for both experiments, whereas event-related potential components N1, N2, and P3 were assessed only in Experiment 2.

Results

The results of Experiment 1 showed that anticipatory accuracy was significantly higher among athletes than non-athletes and that anticipatory accuracy with directional information given was significantly higher than that when no prior information was given or when prior information without directional information was given (p < 0.001) for both T-1 (p's ≤ 0.034) and T-2 (p's < 0.001) occlusion points. In Experiment 2 using those two video occlusion times, the amplitude of the N1 component, which reflects selective attention to stimulus properties, was significantly higher in athletes than in non-athletes (p < 0.001). The amplitude of the N2 component, which has been associated with conflict monitoring, for the incongruent condition was significantly higher than that for both neutral (p < 0.001) and congruent (p < 0.001) conditions in athletes. Non-athletes exhibited no significant N2 amplitude differences for any prior information condition.

Conclusion

Integrating prior information enhanced action anticipation in semi-elite soccer players, particularly 50 and 100 ms before the foot-ball contact. Semi-elite soccer players prioritized early selective attention and conflict monitoring of kinematic information, facilitating action anticipation using the prior information.

Non-instrumental information seeking is resistant to acute stress

Previous research has shown that people intrinsically value non-instrumental information, which cannot be used to change the outcome of events, but only provides an early resolution of uncertainty. This is true even for information about rather inconsequential events, such as the outcomes of small lotteries. Here we investigated whether participants' willingness to pay for non-instrumental information about the outcome of simple coin-flip lotteries with guaranteed winnings was modulated by acute stress. Stress was induced using the Socially Evaluated Cold Pressor Test (SECPT), and information-seeking choices were compared to a warm water control group. Our results neither support the hypothesis that stress decreases information-seeking by directing cognitive resources away from the relevance of the lotteries, nor the opposite hypothesis that stress increases information-seeking by driving anxiety levels up. Instead, we found that despite successful stress induction, as evidenced by increased saliva cortisol levels in the SECPT group, information valuation was remarkably stable. This finding is in line with recent findings that experimentally increased state anxiety did not modulate non-instrumental information seeking. Together, these results suggest that the aversiveness of "not knowing" is a stable cognitive state and not easily modulated by situational context, such as acute stress.

The non-unitary nature of information preference

Factors affecting information-seeking behaviour can be task-endogenous (e.g., probability of winning a gamble), or task-exogenous (e.g., personality trait measures). Various task-endogenous factors affecting non-instrumental information-seeking behaviour have been identified, but it is unclear how task-exogenous factors affect such behaviour, and if they interact with task-endogenous factors. In an online information seeking experiment (N = 279), we focus on the role that outcome probability, as a task-endogenous factor, has on information preferences. We find reliable preference for advance information on highly probable gains and low preference for highly probable losses. Comparisons with individual trait measures of information preference (e.g., intolerance of uncertainty scale, obsessive-compulsive inventory, information preferences scale) reveal minimal association between these task-exogenous factors with choice task performance. We also find minimal interaction between outcome probability and individual trait measures. Despite the choice task and trait measures purportedly tapping the same (or similar) construct, the absence of clear relationships ultimately suggests a multi-dimensional nature of information preference.

'You're never pregnant in the same way again': prior early pregnancy loss influences need for health care and support in subsequent pregnancy

STUDY QUESTION

What are couples' needs for health care and support in a subsequent pregnancy after prior early pregnancy loss (PL) and how do needs change across the pregnancy?

SUMMARY ANSWER

Couples described unmet needs for pregnancy care in the first 20 weeks of pregnancy and were more satisfied with the care provided during the remainder of the pregnancy.

WHAT IS KNOWN ALREADY

Despite early PL being common (∼25% of pregnancies), there is a paucity of research to guide practice to optimize treatment and support future pregnancies. There has been low priority for the issue in research and a pervasive acceptance that couples should 'just try again' after experiencing PL. Women with prior PL report increased anxiety during the first trimester of pregnancy compared to those without previous PL. No longitudinal studies explore what couples' needs are throughout the pregnancy and how these needs shift across time.

STUDY DESIGN SIZE DURATION

This was a qualitative longitudinal dyadic (joint) interview study. In total, 15 couples who were pregnant after a prior PL were interviewed four times over their pregnancy. Couples were recruited from the Copenhagen Pregnancy Loss Cohort Research Programme. Interviews were held in person at the hospital or university, or online. Interviews ranged from 20 to 91 min (mean = 54 min).

PARTICIPANTS/MATERIALS SETTING METHODS

Inclusion criteria included couples with one to two prior early PL(s) who self-reported a new pregnancy and were willing to be interviewed together and in English. Couples were interviewed four times: after a positive pregnancy test and once in each trimester. Interviews were transcribed and data were analysed using thematic analysis to compare and contrast needs of the couples at each of the four time periods in the pregnancy and across the entire pregnancy. One same-sex couple and 14 heterosexual couples participated.

MAIN RESULTS AND THE ROLE OF CHANCE

Couples' needs were categorized into two main longitudinal themes across the pregnancy, divided by the 20-week scan. Within each longitudinal theme, there were two themes to represent each time period. In the longitudinal theme 'The first 20 weeks: a 'scary' gap in care' there were two themes: Positive pregnancy test: 'Tell them it's not the same pregnancy' and First trimester: 'We craved that someone was taking care of us'. The standard pregnancy care offered in the public healthcare system in Denmark includes a scan at 12 and 20 weeks. While all couples wished for additional access to scans and monitoring of the foetus in early pregnancy to provide reassurance and detect problems early, they described considerable variation in the referrals and care they were offered. Both partners expressed a high degree of worry and anxiety about the pregnancy, with pregnant women in particular describing 'surviv[ing] from scan to scan' in the early weeks. Couples took scans wherever offered or paid for comfort scans, but this resulted in fragmented care. Instead, they wished for continuity in care, and acknowledgement and sensitivity that a pregnancy after PL is not the same as a first pregnancy. In the longitudinal theme 'The second 20 weeks: Safety in the care system' there were two themes: Second trimester: 'I think we are in good hands' and Third trimester: 'It's more of a 'nice to know' everything is OK than a 'need to know'. Couples reported their distress was lower and overall needs for care were met during this time. They expressed general satisfaction with regular or extended antenatal support although, as in the first 20 weeks, additional acknowledgement and sensitivity regarding their history of PL was desired. Couples said they felt more secure given that they had access to a 24-hour telephone support by midwife/nurse if they had any concerns or questions.

LIMITATIONS REASONS FOR CAUTION

Participants were self-selected from an ongoing cohort study of patients presenting at hospital with PL. Single women were not included in the study. This study was limited to data collection in Denmark; however, other countries with public healthcare systems may have similar offerings with regard to their provision of antenatal care, care provided in recurrent pregnancy loss (RPL) clinics and the availability of private scans.

WIDER IMPLICATIONS OF THE FINDINGS

The findings underscore that an early PL creates an increased need for monitoring and care in a subsequent pregnancy. This study highlights a gap in pregnancy care for those with a history of PL given that their need for monitoring and support is high in the early weeks of a new pregnancy before they have access to antenatal care, and before they have had multiple PLs and can be referred to the RPL unit.

STUDY FUNDING/COMPETING INTERESTS

This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 101028172 for E.K. The Copenhagen Pregnancy Loss Cohort is funded by a grant from the BioInnovation Institute Foundation. H.S.N. has received scientific grants from Freya Biosciences, Ferring Pharmaceuticals, BioInnovation Institute, Ministry of Education, Novo Nordisk Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond, and Independent Research Fund Denmark. H.S.N. received personal payment or honoraria for lectures and presentations from Ferring Pharmaceuticals, Merck, Astra Zeneca, Cook Medical, Gedeon Richter, and Ibsa Nordic. All other authors declare no competing interests.

Curiosity and mesolimbic functional connectivity drive information seeking in real life

Curiosity reflects an individual's intrinsic motivation to seek information in order to close information gaps. In laboratory-based experiments, both curiosity and information seeking have been associated with enhanced neural dynamics in the mesolimbic dopaminergic circuit. However, it is unclear whether curiosity and dopaminergic dynamics drive information seeking in real life. We investigated (i) whether curiosity predicts different characteristics of real-life information seeking and (ii) whether functional connectivity within the mesolimbic dopaminergic circuit is associated with information seeking outside the laboratory. Up to 15 months before the COVID-19 pandemic, curiosity and anxiety questionnaires and a 10-minute resting-state functional magnetic resonance imaging session were conducted. In a follow-up survey early during the COVID-19 pandemic, participants repeated the questionnaires and completed an additional questionnaire about their COVID-19-related information seeking. Individual differences in curiosity but not anxiety were positively associated with the frequency of information-seeking behaviour. Additionally, the frequency of information seeking was predicted by individual differences in resting-state functional connectivity between the ventral tegmental area and the nucleus accumbens. The present translational study paves the way for future studies on the role of curiosity in real-life information seeking by showing that both curiosity and the mesolimbic dopaminergic functional network support real-life information-seeking behaviour.

Hedonism as a motive for information search: biased information-seeking leads to biased beliefs

Confirmation bias in information-search contributes to the formation of polarized echo-chambers of beliefs. However, the role of valence on information source selection remains poorly understood. In Experiment 1, participants won financial rewards depending on the outcomes of a set of lotteries. They were not shown these outcomes, but instead could choose to view a prediction of each lottery outcome made by one of two sources. Before choosing their favoured source, participants were first shown a series of example predictions made by each. The sources systematically varied in the accuracy and positivity (i.e., how often they predicted a win) of their predictions. Hierarchical Bayesian modeling indicated that both source accuracy and positivity impacted participants' choices. Importantly, those that viewed more positively-biased information believed that they had won more often and had higher confidence in those beliefs. In Experiment 2, we directly assessed the effect of positivity on the perceived credibility of a source. In each trial, participants watched a single source making a series of predictions of lottery outcomes and rated the strength of their beliefs in each source. Interestingly, positively-biased sources were not seen as more credible. Together, these findings suggest that positively-biased information is sought partly due to the desirable emotional state it induces rather than having enhanced perceived credibility. Information sought on this basis nevertheless produced consequential biased beliefs about the world-state, highlighting a potentially key role for hedonic preferences in information selection and subsequent belief formation.

Using the ABC theory of emotion to examine the relationship between health anxiety and health information-seeking behavior among the rural population

Objective

The aim of the current study was to explore the relationship between online and offline health information-seeking behaviors, as antecedents and consequences, and health anxiety and related belief factors in rural residents.

Methods

Based on the ABC theory of emotions (ABC model), this study developed two theoretical models of the association between health anxiety and health information-seeking behavior: Placing health information-seeking behavior (both online and offline) as an outcome and antecedent, respectively, and setting three belief factors of the perceived health threat, intolerance of uncertainty, and catastrophic misinterpretations. We collected 730 self-reported data points from 20 June to 5 July 2022 for rural residents in China and empirically tested the research model and hypotheses using partial least squares-based structural equation modeling.

Results

The perceived health threat and intolerance of uncertainty are significant motivators of health anxiety, and health anxiety has a direct beneficial effect on both online and offline health information-seeking behaviors. Health anxiety is influenced either directly or indirectly by catastrophic misinterpretations resulting from online health information-seeking, while offline health information-seeking behavior does not contribute as strongly to health anxiety directly but mainly reinforces it through the mediating influence of catastrophic misinterpretations.

Conclusions

Rural residents' health anxiety promotes their online and offline health information behaviors. And both their online and offline health information-seeking behaviors may promote health anxiety directly and through catastrophic misinterpretations. Comparing the two, online health information-seeking behaviors primarily exacerbate health anxiety through direct effects, whereas offline health information-seeking behaviors primarily affect health anxiety through catastrophic misinterpretations. We provide suggested guidelines for alleviating health anxiety and regulating health information behaviors among rural residents.