Health information seeking and the World Wide Web: an uncertainty management perspective

The Effects of Patient-Centered Communication on Emotional Health: Examining the Roles of Self-Efficacy, Information Seeking Frustration, and Social Media Use

The existing literature on the direct association between patient-centered communication (PCC) and emotional well-being often demonstrates inconsistent results. To explain such inconsistency, it is important to explore the mediating and moderating mechanisms underlying this relationship. Built upon the communication pathways model, this study empirically analyzed the Health Information National Trends Survey 5 Cycle 3 dataset (N = 4,709) and tested a moderated mediation model that links PCC to emotional health via information-seeking self-efficacy, with an additional assessment of the moderating effects of information-seeking frustration and social media use. The findings showed that PCC was positively related to emotional health. Also, PCC was indirectly associated with emotional health through information-seeking self-efficacy. In addition, information-seeking frustration and social media use weakened the association between PCC and information-seeking self-efficacy. Furthermore, the indirect path from PCC to emotional health through information-seeking self-efficacy was conditional on both information-seeking frustration and social media use. Important theoretical and practical implications are also discussed.

"We Aren't Here to Win; We are Here Not to Lose": Emergency Physicians' Communicative Management of Uncertainty

Healthcare providers in hospital emergency departments (EDs) work under high uncertainty and pressure to manage a variety of patients efficiently. Whereas much existing research has examined communicative implications of uncertainty from patients' perspectives, we explored ED physicians' experiences of uncertainty in their everyday work environment. Through an ethnographic fieldwork in an ED, we identified three main sources of uncertainty routinely faced by physicians: (a) patients' incorrect expectation about the role of ED; (b); patient variability and ED physicians' breadth of expertise; and (c) emerging and unexpected changes in patient cases after handoffs. We also found how ED physicians managed these uncertainties, including: (1) direct admission of scientific uncertainty to patients; (2) lowering epistemic uncertainty through swift Internet searches; and (3) maintenance of situational uncertainty. We discuss implications of these findings for researchers, providers, and hospital organizations.

The Effects of Patient Health Information Seeking in Online Health Communities on Patient Compliance in China: Social Perspective

BACKGROUND

Online health communities (OHCs) can alleviate the uneven distribution and use of medical resources and severe hospital congestion. Patients may seek health information through OHCs before or after visiting physicians, which may affect their cognition, health literacy, decision-making preferences, and health-related behaviors such as compliance. Social factors (social support, social presence, and responsiveness) are closely related to patients' health information-seeking behavior and are significantly considered in OHCs.

OBJECTIVE

This study aimed to explore the effects of patients' health information-seeking behavior (way and effectiveness) on compliance with physicians from the perspectives of patients' perceived social support, social presence, and responsiveness.

METHODS

This study established a research model from the perspective of social information processing by using the social exchange theory. An anonymous questionnaire survey was conducted with several Chinese OHCs to collect data. Partial least squares and structural equation modeling were adopted to test the hypotheses and develop the model.

RESULTS

This study received 403 responses, of which 332 were valid, giving a validity rate of 82.4% (332/403). Among the sample, 78.6% (261/332) of the individuals were aged between 20 and 40 years, 59.3% (197/332) were woman, 69.9% (232/332) lived in urban areas, and 50% (166/332) had at least a bachelor's degree. The reliability, convergent validity, and discriminant validity were acceptable. Both the way and effectiveness of patients seeking health information through OHCs have a positive impact on their compliance through the mediation of their perceived social support, social presence, and responsiveness from OHCs and other users, and patient compliance can be improved by guiding patient health information-seeking behavior in OHCs from a social perspective.

CONCLUSIONS

This study proposes a research model to corroborate that patient health information-seeking behavior (way and effectiveness) in OHCs exerts positive effects on patient compliance with the treatment and physician's advice and provides suggestions for patients, physicians, and OHC service providers in China to help guide patients' health-related behaviors through OHCs to improve patient compliance, patient satisfaction, treatment efficiency, and health outcomes.

What did the pandemic teach us about effective health communication? Unpacking the COVID-19 infodemic

BACKGROUND

The spread of unvetted scientific information about COVID-19 presents a significant challenge to public health, adding to the urgency for increased understanding of COVID-19 information-seeking preferences that will allow for the delivery of evidence-based health communication. This study examined factors associated with COVID-19 information-seeking behavior.

METHODS

An online survey was conducted with US adults (N = 1800) to identify key interpersonal (e.g., friends, health care providers) and mediated (e.g., TV, social media) sources of COVID-19 information. Logistic regression models were fitted to explore correlates of information-seeking.

RESULTS

Study findings show that the first sought and most trusted sources of COVID-19 information had different relationships with sociodemographic characteristics, perceived discrimination, and self-efficacy. Older adults had greater odds of seeking information from print materials (e.g., newspapers and magazines) and TV first. Participants with less educational attainment and greater self-efficacy preferred interpersonal sources first, with notably less preference for mass media compared to health care providers. Those with more experiences with discrimination were more likely to seek information from friends, relatives, and co-workers. Additionally, greater self-efficacy was related to increased trust in interpersonal sources.

CONCLUSION

Study results have implications for tailoring health communication strategies to reach specific subgroups, including those more vulnerable to severe illness from COVID-19. A set of recommendations are provided to assist in campaign development.

Modeling the Mediating and Moderating Roles of Risk Perceptions, Efficacy, Desired Uncertainty, and Worry in Information Seeking-Cancer Screening Relationship Using HINTS 2017 Data

Despite mixed findings in the literature, health information seeking is considered as a promising antecedent of health behavior and outcome. However, little research has been conducted to identify factors that explain the health information seeking-health behavior relationship. In the contexts of breast, cervical, and prostate cancer screening, this research utilized recently collected Health Information National Trends Survey data (HINTS 5 Cycle 1) to examine whether, among the population at risk of cancer, previous cancer information seeking influenced cancer screening via perceptions of risk and efficacy, desired uncertainty, and worry. The results indicated that previous cancer information seeking had a direct effect on cancer screening. Across the three cancer screening behaviors, desired uncertainty mediated the relationship between previous cancer information seeking and screening behavior. Worry about getting cancer moderated and mediated the relationship between cancer information seeking and cervical cancer screening. Moreover, desired uncertainty and perceived susceptibility respectively interacted with previous cancer information seeking to influence breast cancer screening. Perceptions of risk and efficacy had limited effects on cancer screening. Theoretical and practical implications are discussed.

Explaining Online Information Seeking Behaviors in People With Different Health Statuses: German Representative Cross-sectional Survey

Background

Worldwide, the internet is an increasingly important channel for health information. Many theories have been applied in research on online health information seeking behaviors (HISBs), with each model integrating a different set of predictors; thus, a common understanding of the predictors of (online) HISB is still missing. Another shortcoming of the theories explaining (online) HISB is that most existing models, so far, focus on very specific health contexts such as cancer. Therefore, the assumptions of the Planned Risk Information Seeking Model (PRISM) as the latest integrative model are applied to study online HISB, because this model identifies the general cognitive and sociopsychological factors that explain health information seeking intention. We shift away from single diseases and explore cross-thematic patterns of online HISB intention and compare predictors concerning different health statuses as it can be assumed that groups of people perceiving themselves as ill or healthy will differ concerning their drivers of online HISB. Considering the specifics of online HISB and variation in individual context factors is key for the development of generalizable theories.

Objective

The objective of our study was to contribute to the development of the concept of online HISB in 2 areas. First, this study aimed to explore individual-level predictors of individuals’ online HISB intention by applying the postulates of PRISM. Second, we compared relevant predictors of online HISB in groups of people with different health statuses to identify cross-thematic central patterns of online HISB.

Methods

Data from a representative sample of German internet users (n=822) served to explain online HISB intentions and influencing patterns in different groups of people. The applicability of the PRISM to online HISB intention was tested by structural equation modeling and multigroup comparison.

Results

Our results revealed PRISM to be an effective framework for explaining online HISB intention. For online HISB, attitudes toward seeking health information online provided the most important explanatory power followed by risk perceptions and affective risk responses. The multigroup comparison revealed differences both regarding the explanatory power of the model and the relevance of predictors of online HISB. The online HISB intention could be better explained for people facing a health threat, suggesting that the predictors adopted from PRISM were more suitable to explain a problem-driven type of information-seeking behavior.

Conclusions

Our findings indicate that attitudes toward seeking health information online and risk perceptions are of central importance for online HISB across different health-conditional contexts. Predictors such as self-efficacy and perceived knowledge insufficiency play a context-dependent role—they are more influential when individuals are facing health threats and the search for health information is of higher personal relevance and urgency. These findings can be understood as the first step to develop a generalized theory of online HISB.

Online Health Information Seeking: A Review and Meta-Analysis

Online health information, as an emerging field in health communication research, has attracted close attention from researchers. To identify major determinants of why individuals seek health information online, we conducted a meta-analysis that systematically accumulates the existing research findings. To that end, by integrating three theories or models for examining information-seeking behavior, we developed a theoretical framework for the current meta-analysis that emphasizing psychosocial, instrumental, contextual, and demographic factors. By analyzing the effect sizes from 44 articles representing 54 empirical samples, we found that the quality, trustworthiness, and utility of online health information were the dominant predictors of seeking it and that instrumental factors were more important than psychological ones in determining whether individuals did so. Moreover, the development of information and communication technology, the sampling method, and the type of information sought significantly moderated pairwise relationships between determinants and seeking behavior, whereas culture did not. Herein, we discuss the theoretical implications of our findings as well as directions for future research.

Shared decision-making for prophylactic cranial irradiation in extensive-stage small-cell lung cancer: an exploratory study

Background

Prophylactic cranial irradiation (PCI) offers extensive-stage small-cell lung cancer (ES-SCLC) patients a lower chance of brain metastasis and slightly longer survival but is associated with a short-term decline in quality of life due to side-effects. This tradeoff between survival and quality of life makes PCI suitable for shared decision-making (SDM), where patients and clinicians make treatment decisions together based on clinical evidence and patient preferences. Despite recent clinical practice guidelines recommending SDM for PCI in ES-SCLC, as well as the heavy disease burden, research into SDM for lung cancer has been scarce. This exploratory study presents patients’ experiences of the SDM process and decisional conflict for PCI.

Methods

Radiation oncologists (n=7) trained in SDM applied it in making the PCI decision with ES-SCLC patients (n=25). We measured patients’ preferred level of participation (Control Preferences Scale), the level of SDM according to both groups (SDM-Q-9 and SDM-Q-Doc), and patients’ decisional conflict [decisional conflict scale (DCS)].

Results

Seventy-nine percent of patients preferred a collaborative role in decision-making, and median SDM scores given by patients and clinicians were 80 (IQR: 75.6–91.1) and 85.2 (IQR: 78.7–88.9) respectively, indicating satisfaction with the process. However, patients experienced considerable decisional conflict. Over 50% lacked clarity about which choice was suitable for them and were unsure what to choose. Sixty-four percent felt they did not know enough about the harms and benefits of PCI, and 60% felt unable to judge the importance of the harms/benefits in their life.

Conclusions

ES-SCLC patients prefer to be involved in their treatment choice for PCI but a substantial portion experiences decisional conflict. Better information provision and values clarification may support patients in making a choice that reflects their preferences.

Pre-exposure Prophylaxis (PrEP) Information on Instagram: Content Analysis

Background

There is still an HIV epidemic in the United States, which is a substantial issue for populations bearing a disproportionate burden of HIV infections. Daily oral pre-exposure prophylaxis (PrEP) has proven to be safe and effective in reducing HIV acquisition risk. However, studies document that PrEP awareness/usage is low. There is also limited understanding of social media platforms, such as Instagram, as PrEP information sources.

Objective

Given the paucity of research on PrEP-related Instagram posts and popularity of this social media platform, the purpose of this research is to describe the source characteristics, image types, and textual contents of PrEP-related posts on Instagram.

Methods

Using Crowdtangle Search, a public insights tool owned/operated by Facebook, we retrieved publicly accessible and English-language-only Instagram posts for the 12-month period preceding April 22, 2020, using the following terms: Truvada or “pre-exposure prophylaxis” or #truvada or #truvadaprep or #truvadawhore or #truvadaforprep. We employed a qualitative coding methodology to manually extract information from posts. Using a pretested codebook, we performed content analysis on 250 posts, examining message and source characteristics (ie, organization type [eg, government, news] and individual type [eg, physician]), including information about PrEP (eg, how it works, cost), and indicated users. Frequencies and percentages were calculated for all categorical variables. A Chi-square test was conducted to determine differences between source types on a variety of message characteristics.

Results

Three-quarters of the posts (193/250, 77.2%) were posted by organizations. Of the 250 posts reviewed, approximately two-thirds (174/250, 69.6%) included a photograph, more than half (142/250, 56.8%) included an infographic, and approximately one-tenth (30/250, 12%) included a video. More than half defined PrEP (137/250, 54.8%), but fewer posts promoted PrEP use, explained how PrEP works, and included information on the effectiveness of PrEP or who can use it. The most commonly hashtagged populations among posts were men who have sex with men (MSM), but not necessarily bisexual men. Few posts contained race-/ethnicity-related hashtags (11/250, 4.4%). Fewer posts contained transgender-associated tags (eg, #transgirl; 5/250, 2%). No posts contained tags related to heterosexuals or injection drug users. We found statistical differences between source types (ie, individual versus organization). Specifically, posts from organizations more frequently contained information about who can use PrEP, whereas posts from individuals more frequently contained information describing adverse effects.

Conclusions

This study is among the first to review Instagram for PrEP-related content, and it answers the National AIDS Strategy’s call for a clearer articulation of the science surrounding HIV risk/prevention through better understanding of the current public information environment. This study offers a snapshot of how PrEP is being discussed (and by whom) on one of the most popular social media platforms and provides a foundation for developing and implementing PrEP promotion interventions on Instagram.

Few changes shown in cancer information-seeking behaviour among young adults in China between 2012 and 2017

BACKGROUND

The increasing incidence of cancer among young adults (18-40 years old) is of concern in China.

OBJECTIVES

This study aims to examine the influence of cancer information-seeking behaviours (CISB) on young adults' worries about cancer and participation in screening.

METHODS

This study analysed data from two probability sample surveys conducted in 2012 and 2017 in China. The questions in the questionnaire remained the same for better comparison. The sample size was 1212 in the 2012 survey, and 2178 in the 2017 survey.

RESULTS

From 2012 to 2017, among young adults, there was a decline in cancer information seeking, diversity of cancer information sought and cancer worry, while an improvement in cancer information-seeking experience was found. Also, CISB had significant associations with cancer worry and health screening over the 5 years.

DISCUSSION

The level of young adults' cancer information seeking remains low in China, and this group is not fully aware of their potential risks of getting cancer.

CONCLUSION

Although young adults find the experience of looking for cancer information easier in 2017, health campaigns may be necessary to encourage young adults to find out more about their cancer risks, and to participate more in health screening.

Online Health Information Seeking Using "#COVID-19 Patient Seeking Help" on Weibo in Wuhan, China: Descriptive Study

Background

First detected in Wuhan, China in December 2019, the COVID-19 pandemic stretched the medical system in Wuhan and posed a challenge to the state’s risk communication efforts. Timely access to quality health care information during outbreaks of infectious diseases can be effective to curtail the spread of disease and feelings of anxiety. Although existing studies have extended our knowledge about online health information–seeking behavior, processes, and motivations, rarely have the findings been applied to an outbreak. Moreover, there is relatively little recent research on how people in China are using the internet for seeking health information during a pandemic.

Objective

The aim of this study is to explore how people in China are using the internet for seeking health information during a pandemic. Drawing on previous research of online health information seeking, this study asks the following research questions: how was the “#COVID-19 Patient Seeking Help” hashtag being used by patients in Wuhan seeking health information on Weibo at the peak of the outbreak? and what kinds of health information were patients in Wuhan seeking on Weibo at the peak of the outbreak?

Methods

Using entity identification and textual analysis on 10,908 posts on Weibo, we identified 1496 patients with COVID-19 using “#COVID-19 Patient Seeking Help” and explored their online health information–seeking behavior.

Results

The curve of the hashtag posting provided a dynamic picture of public attention to the COVID-19 pandemic. Many patients faced difficulties accessing offline health care services. In general, our findings confirmed that the internet is used by the Chinese public as an important source of health information. The lockdown policy was found to cut off the patients’ social support network, preventing them from seeking help from family members. The ability to seek information and help online, especially for those with young children or older adult members during the pandemic. A high proportion of female users were seeking health information and help for their parents or for older adults at home. The most searched information included accessing medical treatment, managing self-quarantine, and offline to online support.

Conclusions

Overall, the findings contribute to our understanding of health information–seeking behaviors during an outbreak and highlight the importance of paying attention to the information needs of vulnerable groups and the role social media may play.

Tobacco Risk Information and Comparative Risk Assessment of E-Cigarettes Vs. Cigarettes: Application of the Reinforcing Spirals Model

We examine how individuals seek information about e-cigarette risk and selectively expose themselves to media sources that may provide information consistent with their existing beliefs and behaviors related to e-cigarettes in application of the Reinforcing Spirals Model (Slater, 2007). Additionally, the associations among e-cigarette risk information-seeking, tobacco risk information exposure via media, and comparative risk assessment of e-cigarettes versus conventional cigarettes were identified. The results were compared among current users, former users, and those who had never used e-cigarettes ("never users"). A nationally representative data from the 2017 Health Information National Trends Surveys - FDA was employed. Our analyses suggest the presence of comparative risk perception among current users as assessing the health harm and addiction risk of e-cigarettes significantly lower than cigarettes. Current users did not avoid information about the health effects of e-cigarettes; they were more likely to look for such information than former and never users. Current users' e-cigarette risk information-seeking was negatively associated with the difference between perceived addiction risk of e-cigarettes and that of cigarettes. Current users' tobacco risk information exposure via social media was related with a lower level of the perceived risk of e-cigarettes, while such exposure via news media was related with a higher level of perceived risk of e-cigarettes. Our findings suggest the need for regulating and counteracting the prevalent e-cigarette information that discounts the relative risks of e-cigarettes as well as the potential of news media as influential sources helping current users scrutinize the risks.

Does consumer medicines interest reflect medicines use? An observational study comparing medicines call center queries with medicines use

BACKGROUND

Consumers have questions about their medication but the nature of these concerns and how they reflect medication use is unknown.

OBJECTIVES

To determine the characteristics and medicines interests of callers to an Australian medicines call center and whether the medicines interest of callers corresponds with medicines utilization.

METHODS

Data from consumers who contacted a national medicines call center between September 2002 and June 2010 were analyzed. Patterns of consumer medicines interest were described. Medicines were class-matched by Anatomical Therapeutic Classification, and compared with dispensed use (January 2006-June 2010).

RESULTS

In total 125,951 calls were received between 2002 and 2010. Callers were mainly female (76.8%), median age 48 years, calling for themselves (71.7%). Motivation to call related to safety (34.7%), efficacy (24.1%) and interactions (14.9%). For the comparison with medicines utilization, 85,416 calls with 124,177 individual medicine counts were analyzed (2006 and 2010). There were 976 unique 'medicines of interest'. Half (49.4%) of these questions involved just fifty unique medicines. Nervous system medicines (antiepileptics, psycholeptics, analgesics) and antibacterials consistently ranked highest for interest compared with use. Conversely, agents acting on the renin-angiotensin system, statins and drugs for acid related disorders ranked low for interest despite widespread use.

CONCLUSIONS

Consumer questions about medicines correlate poorly with overall medicines utilization. To promote quality health outcomes, clinicians should target their education to the relatively small number of medicines of real concern to patients.

Online health information seeking among women: the moderating role of health consciousness

Purpose

The purpose of this paper is two fold: to test the moderating effect of health consciousness (HC) on the influence of attitude towards internet (AI) internet usage for health information seeking (IHI) behaviour; and examine whether HC moderates the influence of perceived health risk (PHR) on the internet usage for health information which is mediated by perceived usefulness of internet (PUI) and AI usage in an integrated model underpinned by health belief model and the technology acceptance model.

Design/methodology/approach

Data obtained for the current study were collected using convenience sampling and the sample consisted of women who not only have internet access but used the internet in their daily life. Partial Least Squares Structural Equation Modelling (PLS-SEM) method was used to test the research hypotheses developed from a sample of 270 respondents.

Findings

Findings revealed that HC moderates the influence of AI use for health information seeking. In addition, the results also showed that the positive indirect effect of PHR on IHI through PUI and AI usage is significant for high level of HC but not for the medium and low levels of HC.

Originality/value

Major contribution of this study is in the testing of the moderating role of HC on the mediating effect of perceived usefulness of the internet and attitude on PHR and IHI.

The "New Public" and the "Good Ol' Press": Evaluating Online News Sources During the 2013 Polio Outbreak in Israel

The current research focuses on the 2013 polio outbreak in Israel as a case study to analyze the sources of information used in new media platforms, examining whether the new media have changed the ways in which we communicate about health issues. Specifically, we tracked and coded polio-related references on Hebrew news websites, blogs, forums, and Facebook posts. Overall, 24,388 polio-related references constituted our sampling frame. The findings suggest that there is a moderate-level correlation between the platform and the type of sources chosen by users. Beyond the differences between various platforms, we found that online information platforms rely not only on popular or pseudoscientific sources, but also on high-quality information. In fact, the analysis indicates that online news websites, forums, blogs, and Facebook posts create a unique blend of information, including scientific literature, medical professionals, and government representatives, as well as pseudoscientific research. These findings suggest a more optimistic view of the Internet as a source for health-related information in times of crises. Although the fact that members of the public are exposed to scientific sources does not indicate to what degree this affects their actual decision making. Exposure to a wider variety of sources may enhance health literacy, resulting in a better understanding of information needed to make informed decisions.

Communicating Effectively About Clinical Trials With African American Communities: A Comparison of African American and White Information Sources and Needs

Clinical trial (CT) participation is low among African Americans (AAs). To better communicate with AAs about the importance of CTs, the purpose of this study was to explore the communication sources and perceived effective communication channels and strategies through which the general public, AAs, and White individuals receive CT information. A quantitative telephone survey was conducted with AAs and Whites in one Southern state (N = 511). The measures assessed CT sources of information, perceived effectiveness of communication channels and strategies, CT understanding, and CT participation. Descriptive and bivariate analyses were used to compare responses overall and by race. AAs reported being exposed to more CT information than Whites. AAs received CT information most often through television, social media, and doctors compared to Whites. Perceived effectiveness of communication strategies and channels varied by race. AAs preferred simple and easy-to-understand CT information distributed through faith-based organizations. Whites preferred to receive CT information through a trustworthy source (e.g., doctor). There were no significant differences between AAs and Whites in their perceived effectiveness of media sources (e.g., Internet). Recommendations are provided to help health promotion practitioners and CT recruiters tailor information and communicate it effectively to potential AA and White CT participants.

Association between information provision and decisional conflict in cancer patients

BACKGROUND

In this study, we aimed to identify demographic and clinical variables that correlate with perceived information provision among cancer patients and determine the association of information provision with decisional conflict (DC).

PATIENTS AND METHODS

We enrolled a total of 625 patients with cancer from two Korean hospitals in 2012. We used the European Organization for Research and Treatment of Cancer (EORTC) quality-of-life questionnaire (QLQ-INFO26) to assess patients' perception of the information received from their doctors and the Decisional Conflict Scale (DCS) to assess DC. To identify predictive sociodemographic and clinical variables for adequate information provision, backward selective logistic regression analyses were conducted. In addition, adjusted multivariate logistic regression analyses were carried out to identify clinically meaningful differences of perceived level of information subscales associated with high DC.

RESULTS

More than half of patients with cancer showed insufficient satisfaction with medical information about disease (56%), treatment (73%), other services (83%), and global score (80%). In multiple logistic regression analyses, lower income and education, female, unmarried status, type of cancer with good prognosis, and early stage of treatment process were associated with patients' perception of inadequate information provision. In addition, Information about the medical tests with high DCS values clarity [adjusted odds ratio (aOR), 0.54; 95% confidence interval (CI) 0.30-0.97] and support (aOR, 0.53; 95% CI 0.33-0.85) showed negative significance. For inadequate information perception about treatments and other services, all 5 DCS scales (uncertainty, informed, values clarity, support, and effective decision) were negatively related. Global score of inadequate information provision also showed negative association with high DCS effective decision (aOR, 0.43; 95% CI 0.26-0.71) and DCS uncertainty (aOR, 0.46; 95% CI 0.27-0.77).

CONCLUSION

This study found that inadequate levels of perceived information correlated with several demographic and clinical characteristics. In addition, sufficient perceived information levels may be related to low levels of DC.