Internet health information seeking behavior and antiretroviral adherence in persons living with HIV/AIDS

Quality and readability of web-based information on dental caries in Arabic: an infodemiological study

BACKGROUND

Web-based information on dental caries in Arabic remains poorly understood. This study aimed to assess the quality and readability of web-based information about dental caries in Arabic.

METHODS

The first 100 websites in Arabic about dental caries were retrieved from Google and Bing using common terms. The websites were classified and evaluated for quality based on the Journal of the American Medical Association (JAMA) benchmark criteria, the DISCERN tool, and the presence of the Health on the Net Foundation Code of Conduct (HONcode). Readability was assessed using online readability indexes.

RESULTS

A total of 102 Arabic websites were included. The JAMA benchmark score was low (m = 0.36, SD = 0.56), with 67.7% failing to meet any of the JAMA criteria. The DISCERN total score mean was 37.68 (SD = 7.99), with a majority (67.65%) of moderate quality. None of the websites had the HONcode. Readability was generally good, with 52.94% of websites having a Flesch-Kincaid Grade Level (FKGL) < 7, 91.18% having a Simple Measure of Gobbledygook (SMOG) < 7, and 85.29% having a Flesch reading ease (FRE) score ≥ 80. There was a positive correlation between JAMA and DISCERN scores (p < 0.001). DISCERN scores were positively correlated with the number of words (p < 0.001) and sentences (p = 0.004) on the websites. However, JAMA or DISCERN scores were not correlated with FKGL, SMOG, or FRE scores (p > 0.05).

CONCLUSIONS

The quality of Arabic dental caries websites was found to be low, despite their readability. Efforts are needed to introduce more reliable sources for discussing dental caries and treatment options on sites aimed at Arabic populations.

Health literacy mediates the effects of educational attainment on online pharmacy navigation skills in older adults with HIV disease

ObjectiveThe Internet serves an increasingly critical role in health behaviors for older adults with chronic medical conditions. Guided by theories of health behaviors and literacy, this study examined whether the relationship between educational attainment and online pharmacy skills in older persons with HIV disease (PWH) is mediated by health literacy. Design: Participants included 98 PWH age 50 and older who completed the Test of Online Pharmacy Skills (TOPS), which required them to navigate an experimenter-controlled online pharmacy to perform several naturalistic tasks (e.g., refill an existing prescription). Participants also completed the Medication-Management Test-Revised (MMT-R). Results: Mediation analyses revealed a significant indirect effect of education on both online pharmacy accuracy and MMT-R, which was fully mediated by health literacy. In contrast, there was no direct or indirect effect of education on online pharmacy speed when health literacy was included as a mediator. Conclusion: Health literacy plays an important role in the relationship between years of education attained and the ability of older PWH to successfully navigate online pharmacy tasks and manage their medications. Future studies might examine whether interventions to improve electronic health literacy among older PWH who have lower educational attainment have beneficial effects on online health behaviors.

Self- and surrogate-seeking of information about mental health and illness in Germany

BACKGROUND

Seeking information on mental health issues - both for oneself and on behalf of others (so-called surrogate-seeking) - is a critical early step in dealing with mental illness and known to impede stigmatizing attitudes and foster help-seeking. Yet, knowledge about mental health tends to be insufficient worldwide. Therefore, it is necessary to better understand the search for mental health information and examine the factors that are positively associated with information-seeking.

METHOD

In a face-to-face survey in Germany (N = 1,522), we investigated the factors related to mental health information-seeking. The data was analyzed by means of a logistic regression model, in which we distinguished those searching information for themselves from so-called surrogate seekers, i.e., people who seek information on behalf of someone else.

RESULTS

Twenty-six percent of German adults in our sample have already searched for information on mental health, with the majority already having searched for information for others (73% of all seekers). Our findings indicate that individuals' proximity to people with mental health issues, including their own mental health treatment experience (Cramer's V = .429, p < .001), education (Cramer's V = .184, p < .001), and desire for social distance from the affected people (F [1, 1516] = 73.580, p < .001, η² = .046), play an important role in mental health information-seeking. The patterns of sociodemographic and proximity factors hereby differ between self-seekers and surrogate-seekers.

CONCLUSIONS

Our study provides insights into the public's mental health information orientation. The findings may particularly guide strategies to improve mental health awareness and fill knowledge gaps in supporting informed decision-making and reducing stigma. Surrogate seekers appear to be an important and distinctive target group for mental health information provision. Depending on whether one wants to promote surrogate- or self-seeking seekers, different target groups and determinants should be addressed.

Global Online Interest in HIV/AIDS care Services in the time of COVID-19: A Google Trends Analysis

The Covid-19 pandemic has compounded the challenge of HIV/AIDS elimination, creating difficulties in accessing HIV care services such as early testing and treatment. This paper characterized the global online interest in HIV care services-related search terms before and during the pandemic. Global online search interest for HIV was measured using the Google Trends™ database. Spearman's rank-order correlation correlated country-specific characteristics and HIV prevalence data with the search volume index (SVI). We found a significant decrease in the global online search interest for HIV/AIDS care services-related search terms during the Covid-19 pandemic. The top countries with the highest online interest for "HIV/AIDS" search terms were Zambia, Eswatini, Malawi, Lesotho, and Zimbabwe. In addition, search volume indices for HIV correlated positively with HIV prevalence and negatively with GDP, GDP per capita, and the number of physicians. This result highlights that resource-poor countries with a high prevalence of HIV have a high online interest in HIV/AIDS. Therefore, there is a need to improve internet access, the quality of HIV-related health information, and online health literacy to improve health-seeking behavior, especially in areas with a high disease burden. Overall, our study shows that the infodemiologic approach through Google Trends™ can be used to assess the online interest of the public toward HIV infection and related healthcare services.

Impacts of Internet Use on Chinese Patients' Trust-Related Primary Healthcare Utilization

Background: The internet has greatly improved the availability of medical knowledge and may be an important avenue to improve patients’ trust in physicians and promote primary healthcare seeking by reducing information asymmetry. However, very few studies have addressed the interactive impacts of both patients’ internet use and trust on primary healthcare-seeking decisions. Objective: To explore the impact of internet use on the relationship between patients’ trust in physicians and primary healthcare seeking among Chinese adults 18 years of age and older to understand the varieties of effects in different cities. Methods: Generalized linear mixed models were applied to investigate the interactive impacts of internet use and patients’ trust in physicians on primary healthcare seeking using pooled data from the China Family Panel Study of 2014 to 2018. We also compared these effects based on different levels of urbanization, ages, and PHC services. Results: Overall, a higher degree of patients’ trust (p < 0.001) was able to directly predict better primary healthcare seeking, and internet use significantly increased the positive effect of patients’ trust on primary healthcare seeking (p < 0.001). However, the marginal effect analysis showed that this effect was related to the level of patients’ trust and that internet use could reduce the positive effect of patients’ trust on primary healthcare seeking when the individual had a low level of trust (≤ 3 units). Further, the heterogeneity analysis indicated that the benefits from internet use were higher in cities with high urbanization, high aging, and high PHC service levels compared to cities with low levels of these factors. Conclusions: The internet use may enhance patients’ trust-related PHC utilization. However, this impact is effective only if patients’ benchmark trust remains at a relatively high level. Comparatively, the role of internet use is more effective in areas with high urbanization, high aging and high PHC level. Thus, with increasing accessibility to the internet, the internet should be regulated to disseminate correct healthcare information. Moreover, in-depth integration of the internet and PHC should be promoted to provide excellent opportunities for patient participation, and different strategies should be set according to each city’s characteristics.

Effect of the whole seamless connection of nursing from WeChat interactive platform on stigma and quality of life in patients with urinary system cancer

Objective

To evaluate the effects of intervention by “whole seamless connection of nursing from WeChat interactive platform” on stigma and quality of life of the patients with urinary system cancer.

Methods

Overall, 80 patients with urinary cancer were randomly divided (40 cases per group) into control and observation groups. Routine nursing was provided to the control group, whereas positive psychological intervention was provided to the intervention group through a “whole seamless connection of nursing from the WeChat interactive platform” in addition to routine nursing. The Chinese version of social impact and cancer patients’ quality of life scales were used to evaluate the effects before and after the intervention.

Results

After the intervention, the total score for stigma was significantly lower (p < 0.01), while that of quality of life was higher (p < 0.05) in the observation group relative to the control group.

Conclusions

The whole seamless connection of nursing from the WeChat interactive platform could reduce stigma and improve the quality of life of patients with urinary cancer.

Association between online health information-seeking and medication adherence: A systematic review and meta-analysis

Background

The evidence of the impact of online health information-seeking (OHIS) on health outcomes has been conflicting. OHIS is increasingly recognised as a factor influencing health behaviour but the impact of OHIS on medication adherence remains unclear.

Objectives

We conducted a systematic review and meta-analysis to examine the associations between OHIS and medication adherence.

Methods

We searched Medline, Embase, Web of Science, Scopus, CINAHL and Psychology and Behavioural Science Collection for studies published up to December 2020. The inclusion criteria were studies that reported the associations of OHIS and medication adherence, quantitative design, reported primary data only, related to any health condition where medications are used and conducted on patients either in clinical or community settings. A meta-analysis was used to examine the association between OHIS and medication adherence.

Results

A total of 17 studies involving 24,890 patients were included in this review. The study designs and results were mixed. In the meta-analysis, there was no significant association (n = 7, OR 1.356, 95% CI 0.793-2.322, p = 0.265), or correlation (n = 4, r = -0.085, 95% CI −0.572-0.446, p = 0.768) between OHIS and medication adherence. In the sub-group analysis of people living with HIV/AIDS, OHIS was associated with better medication adherence (OR 1.612, 95% CI 1.266-2.054, p < 0.001).

Conclusions

The current evidence of an association between OHIS and medication adherence is inconclusive. This review highlights methodological issues on how to measure OHIS objectively and calls for in-depth exploration of how OHIS affects health decisions and behaviour.

HIV Information Acquisition and Use Among Young Black Men Who Have Sex With Men Who Use the Internet: Mixed Methods Study

Background

HIV disproportionately affects young Black men who have sex with men (YBMSM) in the United States. eHealth holds potential for supporting linkage and engagement in HIV prevention and care and the delivery of HIV information to YBMSM.

Objective

This study aims to investigate HIV information acquisition and use among YBMSM who use the internet.

Methods

A web-based self-administered survey and semistructured interviews were conducted. The survey findings informed the development of the interview guide. Descriptive statistics were used to characterize the survey sample, and interview data were analyzed thematically using modified grounded theory methodologies.

Results

Among the internet sample (N=83), the average age was 29.2 (SD 3.5) years, 41% (n=34) of participants self-reported living with HIV, 43% (n=36) were HIV-negative, and 15% (n=13) were unsure of their HIV status. Most participants (n=79, 95%) acquired HIV information through the internet while using a mobile phone. Web-based HIV information was intentionally sought from consumer health information websites (n=31, 37%), government health information websites (n=25, 30%), and social media (n=14, 17%). Most men incidentally acquired HIV information via advertisements on social media sites and geospatial dating apps (n=54, 65%), posts on social media sites from their web-based social ties (n=44, 53%), and advertisements while browsing the internet (n=40, 48%). Although the internet is the top source of HIV information, health care providers were the most preferred (n=42, 50%) and trusted (n=80, 96%) source of HIV information. HIV information was used to facilitate the use of HIV prevention and care services. The qualitative sample included YBMSM across a range of ages and at different points of engagement in HIV prevention and care. Qualitative findings included the importance of the internet as a primary source of HIV information. The internet was used because of its ease of accessibility, because of its ability to maintain anonymity while searching for sensitive information, and to mitigate intersecting stigmas in health care settings. Participants used HIV information to assess their risk for HIV and AIDS, support their skill building for HIV prevention, inform patient–doctor communication, and learn about HIV prevention and treatment options. Men expressed concerns about their diminishing access to online spaces for HIV information exchange among YBMSM because of censorship policies on social media sites and the stigmatizing framing and tone of mass media HIV-prevention advertisements encountered while using the internet.

Conclusions

YBMSM in this sample had high utilization of eHealth for HIV information acquisition and use but diminished access to their preferred and most trusted source of HIV information: health care providers. Future eHealth-based HIV interventions culturally tailored for YBMSM should aim to reduce intersectional stigma at the point of care and support patient–provider communication. The findings demonstrate the need for community-informed, culturally tailored HIV messaging and online spaces for informational support exchange among YBMSM.

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

OBJECTIVES

This systematic review assessed the influence of online health information (OHI) search behaviour on health and medical decisions.

METHODS

Eligible studies were identified by searching electronic databases PubMed, Scopus, and CINAHL in February 2020 for studies reporting OHI search behaviour and its influence on health decisions. Information was extracted pertaining to either consumers' (self-reported) perceptions of the influence of OHI on decision-making or the association between online search behaviour and health decision-making.

RESULTS

A total of 3995 articles were screened, with 48 included in the final analysis. The reviewed studies indicated that OHI assisted in making subsequent health related decisions such as asking questions during a consultation, increased professional visits, improved adherence to the advice of a physician, being more compliant with taking medication, and improved self-care.

CONCLUSION

Consumers largely used OHI to support information provided by their physicians. The strength of the patient-provider relationship was considered important in moderating the potential negative outcomes of OHI.

PRACTICE IMPLICATIONS

Health care systems have a unique opportunity to direct OHI search behaviours towards empowering consumers to engage as an informed, active and joint decision-maker in their own health care.

Digital health and management of chronic disease: A multimodal technologies typology

This cross-sectional descriptive study aims to (1) describe the current digital technology (DT) use of people with chronic diseases (CD) by identifying different user profiles and (2) determine whether those profiles have specific characteristics regarding health-related variables and patient-doctor relationship quality (RQ). An online questionnaire assessing the uses of multiple types of DT (the Internet, mobile applications and connected devices) and several dimensions related to health and patient-doctor RQ was completed by 954 individuals living with CD. DT user groups were obtained by k-means cluster analysis and then compared using Mann-Whitney tests. The results show three profiles of DT users: (1) hyperconnected (8.9%, regular users of all DTs), (2) biconnected (19.1%, regular users of the Internet and mobile apps) and (3) hypoconnected (72%, casual users of the Internet only). The hyperconnected and biconnected groups are more empowered, more knowledgeable about their treatment and more committed to their doctors than the hypoconnected group. Nonadherence to treatment, health motivations, self-efficacy for health management and the trust dimension of the patient-doctor RQ did not differ between groups. We conclude by discussing the low use of the most recent technologies in the CD population, although these technologies seem to provide access to health information that empowers patients and leads to a better relationship with their doctors.

Using Search Engine Data to Explore Interest in PrEP and HIV Testing in the United States

We used Google search data from January 1, 2014 to January 1, 2019 to explore public awareness of pre-exposure prophylaxis (PrEP) and HIV testing in the United States. Using two search strings, one for PrEP and one for HIV testing, we compared search volume to state HIV prevalence and new HIV diagnoses. We also used Google News to identify news events related to short-term spikes in search volume. Controlling for poverty, education, and internet access, a one-unit increase in a state's HIV prevalence rate was associated with a 3% increase in PrEP search volume (aPR = 1.03 [1.034, 1.037], P < 0.0001) and HIV testing search volume (aPR = 1.03 [1.030, 1.032], P < 0.0001). Short-term search volume spikes also coincided with celebrity news and pharmaceutical company advertising. We demonstrate that search engine data can be a powerful tool for understanding HIV knowledge-seeking and can provide key insight to the events that drive public interest about HIV online.

Web-based information on the treatment of the mouth in systemic sclerosis

BACKGROUND

To categorise the content and assess the quality and readability of the web-based information regarding treatment of the mouth in systemic sclerosis.

METHODS

An online search using three different search terms regarding the treatment of the mouth in SSc was undertaken using the Google search engine. The first 100 websites from each search were selected for analysis. Data recorded included DISCERN instrument scores along with the Journal of the American Medical Association (JAMA) benchmarks and the presence of the Health on the Net seal (HON). Flesch Reading Ease Scores, Flesch-Kincaid Grade Level, the Simplified Measure of Gobbledygook Index and Coleman-Liau index were calculated to assess readability.

RESULTS

Fifty seven of the first websites remained for analysis after applying appropriate exclusion criteria. The mean overall DISCERN score was 2.37 (±1.01). Only 4 websites (7%) achieved all four JAMA benchmarks. Only 12 websites (21.1%) displayed the HON seal. The reading level was found to be difficult to very difficult among the majority of websites.

CONCLUSION

The overall quality of the available online information concerning the treatment of the mouth of systemic sclerosis is questionable and requires a high level of reading skill. Further efforts should be directed toward establishing higher quality, reliable online information sources on the treatment of oral disease relevant to patients with systemic sclerosis.

Antiretroviral Therapy (ART)-related Knowledge Seeking among People Living with HIV (PLHIV) in China: Role of Information & Communication Technology (ICT)

This paper investigated the use of information communication technology (ICT) to seek antiretroviral therapy (ART)-related knowledge among people living with HIV (PLHIV) taking antiretroviral treatment in Guangxi, China. A total 1902 participants who undertook ART and had used ICT were recruited from 12 sites with the highest cumulative HIV incidence. A questionnaire survey was used to collect data on the participants’ sociodemographic characteristics, clinical outcomes, infections in the family and comorbidity, access to healthcare resources, ICT using behavior in HIV management, and ART-related knowledge. The results showed that 15% of the participants had searched HIV-related information online, fewer participants had contacted healthcare providers via computer (1.6%) or text messaging (11.9%), and only 7.7% of the participants had contacted other PLHIV using ICT. Education had a positive impact on the knowledge level of all three categories of ART-related knowledge. Participants with better medication and mechanisms knowledge were more likely to search HIV-related information online and less likely to contact healthcare providers using text messages. Findings of this study suggested that ICT was used as an effective approach to acquire some type of ART-related knowledge. ICT was underutilized in health communication among the PLHIV in this study due to low education level and insufficient eHealth literacy. Future intervention programs should address the customization of the communication tools and focus on improving the education level and eHealth literacy of the PLHIV to better promote ICT as an efficient platform for ART-related knowledge seeking.

Modeling the Pathway Linking Health Information Seeking to Psychological Well-Being on WeChat

Guided by the three-stage model and the integration of key constructs from the Health Belief Model, this study proposed a conceptual model to delve into the underlying mechanism linking health information seeking to psychological well-being. A nationwide online survey was administered, involving 522 WeChat users in China. The results of structural equation modeling analysis showed that health consciousness and WeChat health information reliability are significant antecedents predicting users' health information-seeking actions on WeChat, while perceived susceptibility, severity, and self-efficacy did not have significant relationships with such behavior. As predicted, the positive relationship between WeChat health information seeking and psychological well-being is mediated by perceived social support. The findings of this study provide both theoretical and practical implications to guide the use of mobile social media as a milieu for health improvement.

Differences Between Races in Health Information Seeking and Trust Over Time: Evidence From a Cross-Sectional, Pooled Analyses of HINTS Data

PURPOSE

Assessed racial disparities in health information-seeking behavior and trust of information sources from 2007 to 2017.

DESIGN

Pooled cross-sectional survey data.

SETTING

Health Information National Trends Survey (HINTS).

PARTICIPATION

Data included 6 iterations of HINTS (pooled: N = 19 496; 2007: n = 3593; 2011: n = 3959; 2013: n = 3185; Food and Drug Administration [FDA] 2015: n = 3738; 2017: n = 3285; and FDA 2017: n = 1736).

MEASURES

Outcome variables were health information seeking, high confidence, and high trust of health information from several sources. Independent variable was race group, controlling for other sociodemographic and socioeconomic variables.

ANALYSIS

Weighted descriptive and multivariate logistic regression for the pooled sample assessed associations by race. Fully interacted models with race-survey year interactions compared differences in outcomes between years.

RESULTS

Black respondents, relative to white, had greater odds of having high confidence in their ability to attain health information, trust of health information from newspapers and magazines, radio, internet, television, government, charitable organizations, and religious organizations. Hispanic respondents, relative to white, had lower odds of seeking health information and trusting health information from doctors. They had higher odds of trusting health information from the radio, the internet, television, charitable organizations, and religious organizations.

CONCLUSION

Disparities between races in trust of information sources remained across time. Understanding optimal information media, their reach, and credibility among racial groups could enable more targeted approaches to developing interventions. Our analytical approach minimized limitations present in the HINTS.

Health information seeking behaviour: a concept analysis

BACKGROUND

In 2007, Lambert and Loiselle conducted an extensive concept analysis of the term health information seeking behaviour (HISB) to examine the concept's level of maturity and critically analyse its characteristics. Since their groundbreaking work, HISB has evolved with the proliferation of ICTs. The Internet is now a common and often preferred medium for the pursuit of health information.

OBJECTIVES

The previous analysis spanned 42 years of literature; this article describes an analysis of the last 10 years of literature on HISB and how online seeking has caused the concept to evolve in the literature.

METHODS

This study used the concept analysis methodology employed by Lambert and Loiselle in the original analysis. It also included a systematic search conducted in five databases to identify studies from 2007 to 2017, using similar inclusion criteria from the original study.

RESULTS

Of the more than 500 articles retrieved, 85 journal articles met the inclusion criteria. Consistent with the original work, articles that included outcomes were identified as either behavioural or cognitive.

CONCLUSION

Most of the attention of the works studied focused on individuals and their information source preferences. This HISB analysis can be incorporated with studies to understand how various communities seek information in online versus non-online contexts.

Exploring the Effects of Patient Activation in Online Health Communities on Patient Compliance

Background: Online health communities (OHCs) are one of the developments related to online health. Patient compliance plays a vital role in improving health treatment outcomes. Patient activation is associated with patient activities in OHCs, such as physician-patient communication and health information seeking. In other words, OHCs influence patient compliance. Therefore, identifying the relationship between patient activation in OHCs and patient compliance is important for improved health outcomes. Methods: This study established a research model consisting of one independent variable (patient activation), four mediators (physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy), one dependent variable (patient compliance) and four control variables (gender, age, education level, and status). Data were obtained through a web-based survey, involving a total of 387 valid participants in China. These data were analyzed and tested through structural equation modeling and partial least squares. Results: Patient activation positively affects patient compliance through the mediation of physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy. Perceived information asymmetry has no direct effect on patient compliance. However, perceived information asymmetry affects patient compliance through the mediation of e-health literacy. Conclusions: Patient compliance is significantly affected by patient activation. Thus, physicians can achieve higher patient compliance by improving patient activation. Guaranteeing and improving the information quality in OHCs is essential for physicians and OHCs operators. Physicians should pay extra attention in cultivating patients' e-health literacy through communications and health information-seeking behaviors to further improve patient compliance.

Living environment, social support, and informal caregiving are associated with healthcare seeking behaviour and adherence to medication treatment: A cross-sectional population study

Despite the well-known associations between local environment and health, few studies have focused on environment and healthcare utilisation, for instance healthcare seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long-term illness, and associations with health-seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004-2014, an annually repeated, large sample, cross-sectional, population-based survey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descriptive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refraining from seeking care and non-adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refraining from seeking care (adjusted OR 1.16, 95% CI 1.00-1.22), and non-adherence (adjusted OR 1.22; 95% CI 1.13-1.31). Refraining from going out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51-1.67) and non-adherence (adjusted OR 1.26, 95% CI 1.17-1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non-adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal caregiver status are associated with lower health-seeking behaviour and non-adherence to prescribed medication.

Count Your Calories and Share Them: Health Benefits of Sharing mHealth Information on Social Networking Sites

This study investigates the relationship between sharing tracked mobile health (mHealth) information online, supportive communication, feedback, and health behavior. Based on the Integrated Theory of mHealth, our model asserts that sharing tracked health information on social networking sites benefits users' perceptions of their health because of the supportive communication they gain from members of their online social networks and that the amount of feedback people receive moderates these associations. Users of mHealth apps (N = 511) completed an online survey, and results revealed that both sharing tracked health information and receiving feedback from an online social network were positively associated with supportive communication. Network support both corresponded with improved health behavior and mediated the association between sharing health information and users' health behavior. As users received greater amounts of feedback from their online social networks, however, the association between sharing tracked health information and health behavior decreased. Theoretical implications for sharing tracked health information and practical implications for using mHealth apps are discussed.

A pathway analysis of exploring how HIV-related stigma affects social capital among people living with HIV/AIDS in China

HIV-related stigma is the most common and serious social problem which people living with HIV/AIDS (PLWHA) have to face. However, the impact of HIV stigma on social capital is not yet clear. Therefore, this study aims to understand the relationship between HIV stigma and social capital, and explore the mechanism of how HIV stigma influences social capital among Chinese PLWHA on this basis. An institutional based cross-sectional study was conducted from Nov 2015 to Jan 2016 in Wuhan, China, using a self-reporting questionnaire. A total of 552 PLWHA participated, and 520 valid questionnaires were included. Multiple linear regression analysis showed that lower education level, lower monthly income, higher internalized stigma, and anticipated stigma were significantly associated with lower social capital. Results of path analysis showed that although perceived community stigma has no direct effect on social capital, but it can affect social capital through internalized stigma and anticipated stigma. In conclusion, increased HIV stigma and reduced social capital are frequent among PLWHA in China. Perceived community stigma may cause PLWHA to internalize stigma and anticipate stigmatizing experiences, resulting in the reduction of social capital. These findings suggest that perceived community stigma should become the target of stigma intervention strategy among Chinese PLWHA.

Lower Neurocognitive Functioning Disrupts the Effective Use of Internet-Based Health Resources in HIV Disease: The Mediating Effects of General Health Literacy Capacity

HIV-associated neurocognitive impairment is an independent predictor of low general health literacy, which can be associated with poor disease outcomes (e.g., viremia). Given the increasing frequency with which health behaviors occur in an online environment (e.g., health information seeking, provider interactions), there is a specific need to understand the predictors of electronic health (eHealth) literacy of persons living with HIV disease. In this study, 90 HIV+ persons completed the eHealth Literacy Scale (eHEALS), which measures one's awareness, skills and evaluation of online health resources. Participants also completed a comprehensive battery of clinical neurocognitive tests and well-validated performance-based measures of general health literacy capacity (e.g., knowledge, numeracy). Results showed that, independent of education, lower neurocognitive function was moderately related to lower eHEALS scores, particularly in the domains of learning and motor skills. Of particular note, general health literacy capacity emerged as a significant mediator of the relationship between neurocognition and eHealth literacy. Thus, the adverse effects of neurocognition on health literacy capacity carries a downstream adverse influence on HIV+ persons' awareness, skills, and evaluation of health-related resources in the online environment.

Pre-clinical and post-clinical process of committing to e-psychiatric treatment-an evaluation of patient perspective with emphasis on designing cost-effective longitudinal treatment

BACKGROUND

e-Health is a branch of medicine, specializing in providing cost-effective care, using computer-based technologies. This study evaluates the patient-centered perspective on the process of committing to e-based therapies, emphasizing pre-clinical contemplation stage and post-clinical commitment to treatment stage.

METHODS

We set up an online focus group. Participants (15 M, 15 F) were recruited through postings on health sites promoting e-health solutions. Each participant received login information and was asked to participate in a two-hour, moderated and recorded conversation with the principal investigator about the use of e-health solutions.

RESULTS

The results stratify data into two stages of acquisition and processing information about e-health solutions: pre-clinical and clinical. In the pre-clinical stage, most patients are health information seekers, meaning that they seek to learn about e-psychiatric solutions as much as possible, comparing different treatment modalities. To accomplish this, they research health sites, discussion forums, and read review notes to evaluate the best course of action; Patients prioritize finding an easy and affordable solution that offers access to the qualified provider without the hassle of attending treatment in person. In clinical stage, patients devote time to understanding their interaction with the provider-they look whether the doctor is flexible in offering blended therapeutic approach; they will often tell the physician that they are concerned with cost of treatment, and believe that e-health solutions give them access to a dedicated provider when needed, which lowers the overhead cost of treatment. Once the patient is comfortable with his treatment planning, they establish commitment toward extended psychiatric care.

CONCLUSIONS

This study evaluated how patients decide on what providers to access when seeking e-psychiatric health solutions. We show that the cost of treatment and the provider's commitment to cost-effective, flexible e-health follow-ups predicts the patient's success of remaining in treatment long-term.

Mature or Emerging? The Impact of Treatment-Related Internet Health Information Seeking on Patients' Trust in Physicians

Years of clinical trials have proven the maturity and safety of certain treatments, however, some of these mature treatments may not be highly effective. Several treatments have emerged through technological innovations, but their long-term safety, efficacy, and adverse effects remain unknown. At present, many patients seek information related to their treatments on the Internet, which may impact their attitudes towards different treatments and their trust in physicians. In this study, a research model was developed to examine how patients’ trust in their physicians is influenced by related online information on mature or emerging treatments. The hypotheses were tested using confirmatory factor analysis (CFA) and structural equation modelling (SEM). A total of 336 valid responses were collected through an online survey. Mature treatments related health information was found to significantly improve patients’ trust. Thus, physicians should pay more attention to mature treatments, and encourage their patients to seek related information online. Moreover, the quality of online information should be developed further to increase patients’ satisfaction. Physicians should also consider their patients’ psychological safety in communication with patients to strengthen their trust.

PositiveLinks: A Mobile Health Intervention for Retention in HIV Care and Clinical Outcomes with 12-Month Follow-Up

Mobile health interventions may help People Living with HIV (PLWH) improve engagement in care. We designed and piloted PositiveLinks, a clinic-affiliated mobile intervention for PLWH, and assessed longitudinal impact on retention in care and viral suppression. The program was based at an academic Ryan White Clinic serving a nonurban population in Central Virginia. The PL intervention included a smartphone app that connected participants to clinic staff and provided educational resources, daily queries of stress, mood and medication adherence, weekly quizzes, appointment reminders, and a virtual support group. Outcomes were analyzed using McNemar's tests for HRSA-1, visit constancy, and viral suppression and nonparametric Wilcoxon signed-rank tests for CD4 counts and viral loads. Of 77 participants, 63% were male, 49% black non-Hispanic, and 72% below the federal poverty level. Participants' achievement of a retention in care benchmark (HRSA-1) increased from 51% at baseline to 88% at 6 months (p < 0.0001) and 81% at 12 months (p = 0.0003). Visit constancy improved from baseline to 6 months (p = 0.016) and 12 months (p = 0.0004). Participants' mean CD4 counts increased from baseline to 6 months (p = 0.0007) and 12 months (p = 0.0005). The percentage of participants with suppressed viral loads increased from 47% at baseline to 87% at 6 months (p < 0.0001) and 79% at 12 months (p = 0.0007). This study is one of the first to demonstrate that a mobile health intervention can have a positive impact on retention in care and clinical outcomes for vulnerable PLWH. Next steps include integration with clinical practice and dissemination.

Social Support in a Virtual Community: Analysis of a Clinic-Affiliated Online Support Group for Persons Living with HIV/AIDS

Social support can improve outcomes for people living with HIV (PLWH) and could be provided through online support groups. The Positive Links smartphone app is a multicomponent intervention that allows users to interact in a clinic-affiliated anonymous online support group. We investigated how social support was exchanged in a group of 55 participants over 8 months, using an adaptation of the Social Support Behavior Code. Participant interviews assessed their experiences and perceptions of the app. Of 840 posts analyzed, 115 (14 %) were coded as eliciting social support and 433 (52 %) as providing social support. Messages providing support were predominantly emotional (41 %), followed by network (27 %), esteem (24 %), informational (18 %), and instrumental (2 %) support. Participants perceived connection and support as key benefits of the app. Technical issues and interpersonal barriers limited some participants in fully using the app. Mobile technology offers a useful tool to reach populations with barriers to in-person support and may improve care for PLWH.

Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence

Background

Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. However, a systematic review of the empirical evidence on how empowerment affects medication adherence—the extent to which patients follow the physician’s prescription of medication intake—is still missing. The goal of this systematic review is to sum up current state-of-the-art knowledge concerning the relationship between patient empowerment and medication adherence across medical conditions. As our conceptualization defines health locus of control and self-efficacy as being crucial components of empowerment, we explored the relationship between these two constructs and medication adherence.

Methods

Relevant studies were retrieved through a comprehensive search of Medline and PsychINFO databases (1967 to 2017). In total, 4903 publications were identified. After applying inclusion and exclusion criteria and quality assessment, 154 articles were deemed relevant. Peer-reviewed articles, written in English, addressing the relationship between empowerment (predictor) and medication adherence (outcome) were included.

Findings

High levels of self-efficacy and Internal Health Locus of Control are consistently found to promote medication adherence. External control dimensions were found to have mainly negative (Chance and God attributed control beliefs) or ambiguous (Powerful others attributed control beliefs) links to adherence, except for Doctor Health Locus of Control which had a positive association with medication adherence. To fully capture how health locus of control dimensions influence medication adherence, the interaction between the sub-dimensions and the attitudinal symmetry between the doctor and patient, regarding the patient’s control over the disease management, can provide promising new alternatives.

Discussion

The beneficial effect of patients’ high internal and concurrent physician-attributed control beliefs suggests that a so-called “joint empowerment” approach can be suitable in order to foster medication adherence, enabling us to address the question of control as a versatile component in the doctor-patient relationship.

Factors affecting patients' online health information-seeking behaviours: The role of the Patient Health Engagement (PHE) Model

OBJECTIVE

To identify the variables affecting patients' online health information-seeking behaviours by examining the relationships between patient participation in their healthcare and online health information-seeking behaviours.

METHODS

A cross-sectional survey of Italian chronic patients (N=352) was conducted on patient's online health information-seeking behaviours and patient participation-related variables. Structural equation modeling analysis was conducted to test the hypothesis.

RESULTS

This study showed how the healthcare professionals' ability to support chronic patients' autonomy affect patients' participation in their healthcare and patient's online health information-seeking behaviours. However, results do not confirm that the frequency of patients' online health-information seeking behavior has an impact on their adherence to medical prescriptions.

CONCLUSION

Assuming a psychosocial perspective, we have discussed how patients' engagement - conceived as the level of their emotional elaboration of the health condition - affects the patients' ability to search for and manage online health information.

PRACTICE IMPLICATION

To improve the effectiveness of patients' online health information-seeking behaviours and to enhance the effectiveness of technological interventions in this field, healthcare providers should target assessing and improving patient engagement and patient empowerment in their healthcare. It is important that health professionals acknowledge patients' online health information-seeking behaviours that they discuss the information offered by patients and guide them to reliable and accurate web sources.

Information and Communication Technology Use Is Related to Higher Well-Being Among the Oldest-Old

Objectives

Older adults often prioritize socially meaningful goals over informational goals. Thus, we predicted that using information and communication technology (ICT) in service of socially meaningful versus informational goals relates to higher well-being among the oldest-old.

Method

We surveyed 445 adults aged 80+ (mean = 84, range = 80-93; 64% female; 26% non-White) online or via telephone. Participants reported motivations for ICT use (connect with others, learn new information) and rated their psychological and physical well-being (i.e., life satisfaction, loneliness, goal attainment, subjective health, functional limitations). We conducted regression and mediation analyses to test our hypothesis.

Results

Participants used ICT more to connect with friends/family (M = 3.66, SD = 1.28) than to learn information (M = 2.61, SD = 1.44), p < .001. Overall, ICT use predicted higher well-being across outcomes, ps ≤ .008. Motivations for use differentially mediated these effects: Social motivations mediated the relationships between ICT use and psychological well-being, whereas informational motivations mediated the relationships between ICT use and physical well-being.

Discussion

Older adults aged 80+ use ICT less than other generations, but may have much to gain. Using social versus informational technologies may enhance multiple aspects of well-being in different ways during very late life. Highlighting such benefits may increase ICT adoption among the oldest-old.

A Replication of Channel Complementarity Theory among Internet Users in India

This article examined channel complementarity in health information seeking among Internet users in India. It posited that online users complementarily use different channels to search for health information. Based on the existing literature, it suggested that age is an important moderator of different channels as health information sources. Data regarding the consumption of 11 different channels were collected from nearly 1,000 Internet users. The results demonstrated complementary use of different channels as health information sources in relationship to the Internet as a health information source, except for newspapers and family members. Moreover, not supporting our hypothesis regarding the sources of health information among online users, the Internet was surprisingly not the primary source of health information, being shadowed by the predominant and significantly greater use of newspapers as sources of health information among online users in India. Extending the theory of channel complementarity, we found that age is an important moderator of complementary relationships among various channels as health information sources, demonstrating that younger users were more likely to use greater numbers of channels complementarily as compared to older users. Contributions to channel complementarity and implications of research are discussed on the basis of the findings.

Taking Control: The Efficacy and Durability of a Peer-Led Uncertainty Management Intervention for People Recently Diagnosed With HIV

HIV creates substantial uncertainty for people infected with the virus, which subsequently affects a host of psychosocial outcomes critical to successful management of the disease. This study assessed the efficacy and durability of a theoretically driven, one-on-one peer support intervention designed to facilitate uncertainty management and enhance psychosocial functioning for patients newly diagnosed with HIV. Using a pretest-posttest control group design, 98 participants received information and training in specific communication strategies (e.g., disclosing to friends and family, eliciting social support, talking to health care providers, using the Internet to gather information, and building social networks through AIDS service organizations). Participants in the experimental group attended six 1-hour sessions, whereas control participants received standard of care for 12 months (after which they received the intervention). Over time, participants in the intervention fared significantly better regarding (a) illness uncertainty, (b) depression, and (c) satisfaction with social support than did those in the control group. Given the utility and cost-effectiveness of this intervention and the uncertainty of a multitude of medical diagnoses and disease experiences, further work is indicated to determine how this program could be expanded to other illnesses and to address related factors, such as treatment adherence and clinical outcomes.

Role of the Internet in Care Initiation by People Living With HIV

People frequently use the internet to obtain information, including information about health, but we lack understanding of how people living with HIV (PLHIV) use the internet in their care and treatment decisions. In this secondary analysis, interviews with 23 individuals who initiated HIV care at an urban, Midwestern medical center and mentioned internet use were analyzed using qualitative content analysis to explore how they used the internet during the process of initiating HIV care. HIV care had been initiated by this sample from less than one month to three years post-diagnosis. Participants discussed the internet as a source of information about their diagnosis that influenced their care and treatment decisions. Five themes were predominant: (i) The internet alerted me to the possibility of HIV, (ii) the internet showed me a solution is available, (iii) the internet influenced my decisions about care, (iv) the internet empowered me to participate in my treatment decisions, and (v) the internet gave me hope for my future. The results suggest that the internet has the potential to provide information that can profoundly influence PLHIVs' acceptance of care and treatment decisions. Clinicians face a new reality in which patients use internet resources to obtain information and shape opinions about HIV treatment and care initiation decision-making. Guiding PLHIV in their selection of online resources is one approach to educating and empowering individuals as they cope with their diagnosis and contemplate decisions regarding HIV care and treatment. © 2016 Wiley Periodicals, Inc.

Health information seeking behaviors of ethnically diverse adolescents

Research on health information has primarily focused on the needs of adults or parents of children with chronic illnesses or consumers. There is limited research on the health information needs of adolescents and in particular those from underserved communities. The primary objective of this qualitative study was to understand the health information needs of healthy, urban adolescents, and how they met those needs. Focus group methodology was used to gather information from a sample of ethnically diverse urban adolescents. Data was analyzed using Kriekelas' information seeking behavior framework to, examine the participants'' report of their immediate and deferred health information needs. Our sample of adolescents used several different sources to satisfy their health information needs depending on acuity and severity, which was congruent with Kriekelas' framework. Understanding how adolescents use technology to meet their health information needs, and in what order of preference, will be critical for the development of technology that adolescents find useful and has the potential to decrease health disparities.

Use of communication technologies by people with type 1 diabetes in the social networking era. A chance for improvement

AIMS

To evaluate the health-related use of Web 2.0 tools by patients with type 1 diabetes.

METHODS

Cross-sectional survey assessing views and usage of the Internet, Apps and Web 2.0.

RESULTS

Number of participants: 289 (age 42.8±13.5 years; diabetes duration 18.4±12.2 years; 58.7% males; 39% with an upper secondary or higher education level). Web 2.0 usage for health purposes was low with 19.6% and 14% of Web 2.0 members (147; 50.9%) having health-related contacts and posting health comments. Health-related Apps were used by 35.4% of Smartphone owners (161; 55.7%). 75.3% patients would share information online with professionals, preferably through e-mail (78.7%) rather than Facebook (47.7%). 141 (66.5%) of those willing to share information would participate in a professional-moderated Facebook group.

CONCLUSIONS

Web 2.0 and Apps usage for health purposes is low. The difference between the use of Web 2.0 networks and the willingness to participate in professional-moderated Web 2.0 groups points to the need of a higher implication of health professionals in promoting Web 2.0 technologies if these are to be adopted in a clinical setting. Currently, e-mail is the tool to be considered when aiming to increase online communication with patients with type 1 diabetes.

Consumer Use of "Dr Google": A Survey on Health Information-Seeking Behaviors and Navigational Needs

Background

The Internet provides a platform to access health information and support self-management by consumers with chronic health conditions. Despite recognized barriers to accessing Web-based health information, there is a lack of research quantitatively exploring whether consumers report difficulty finding desired health information on the Internet and whether these consumers would like assistance (ie, navigational needs). Understanding navigational needs can provide a basis for interventions guiding consumers to quality Web-based health resources.

Objective

We aimed to (1) estimate the proportion of consumers with navigational needs among seekers of Web-based health information with chronic health conditions, (2) describe Web-based health information-seeking behaviors, level of patient activation, and level of eHealth literacy among consumers with navigational needs, and (3) explore variables predicting navigational needs.

Methods

A questionnaire was developed based on findings from a qualitative study on Web-based health information-seeking behaviors and navigational needs. This questionnaire also incorporated the eHealth Literacy Scale (eHEALS; a measure of self-perceived eHealth literacy) and PAM-13 (a measure of patient activation). The target population was consumers of Web-based health information with chronic health conditions. We surveyed a sample of 400 Australian adults, with recruitment coordinated by Qualtrics. This sample size was required to estimate the proportion of consumers identified with navigational needs with a precision of 4.9% either side of the true population value, with 95% confidence. A subsample was invited to retake the survey after 2 weeks to assess the test-retest reliability of the eHEALS and PAM-13.

Results

Of 514 individuals who met our eligibility criteria, 400 (77.8%) completed the questionnaire and 43 participants completed the retest. Approximately half (51.3%; 95% CI 46.4-56.2) of the population was identified with navigational needs. Participants with navigational needs appeared to look for more types of health information on the Internet and from a greater variety of information sources compared to participants without navigational needs. However, participants with navigational needs were significantly less likely to have high levels of eHealth literacy (adjusted odds ratio=0.83, 95% CI 0.78-0.89, P<.001). Age was also a significant predictor (P=.02).

Conclusions

Approximately half of the population of consumers of Web-based health information with chronic health conditions would benefit from support in finding health information on the Internet. Despite the popularity of the Internet as a source of health information, further work is recommended to maximize its potential as a tool to assist self-management in consumers with chronic health conditions.

The Association Between Online Health Information-Seeking Behaviors and Health Behaviors Among Hispanics in New York City: A Community-Based Cross-Sectional Study

Background

Hispanics are the fastest-growing minority group in the United States and they suffer from a disproportionate burden of chronic diseases. Studies have shown that online health information has the potential to affect health behaviors and influence management of chronic disease for a significant proportion of the population, but little research has focused on Hispanics.

Objective

The specific aim of this descriptive, cross-sectional study was to examine the association between online health information–seeking behaviors and health behaviors (physical activity, fruit and vegetable consumption, alcohol use, and hypertension medication adherence) among Hispanics.

Methods

Data were collected from a convenience sample (N=2680) of Hispanics living in northern Manhattan by bilingual community health workers in a face-to-face interview and analyzed using linear and ordinal logistic regression. Variable selection and statistical analyses were guided by the Integrative Model of eHealth Use.

Results

Only 7.38% (198/2680) of the sample reported online health information–seeking behaviors. Levels of moderate physical activity and fruit, vegetable, and alcohol consumption were low. Among individuals taking hypertension medication (n=825), adherence was reported as high by approximately one-third (30.9%, 255/825) of the sample. Controlling for demographic, situational, and literacy variables, online health information–seeking behaviors were significantly associated with fruit (β=0.35, 95% CI 0.08-0.62, P=.01) and vegetable (β=0.36, 95% CI 0.06-0.65, P=.02) consumption and physical activity (β=3.73, 95% CI 1.99-5.46, P<.001), but not alcohol consumption or hypertension medication adherence. In the regression models, literacy factors, which were used as control variables, were associated with 3 health behaviors: social networking site membership (used to measure one dimension of computer literacy) was associated with fruit consumption (β=0.23, 95% CI 0.05-0.42, P=.02), health literacy was associated with alcohol consumption (β=0.44, 95% CI 0.24-0.63, P<.001), and hypertension medication adherence (β=–0.32, 95% CI –0.62 to –0.03, P=.03). Models explained only a small amount of the variance in health behaviors.

Conclusions

Given the promising, although modest, associations between online health information–seeking behaviors and some health behaviors, efforts are needed to improve Hispanics’ ability to access and understand health information and to enhance the availability of online health information that is suitable in terms of language, readability level, and cultural relevance.

Women Empowerment through Health Information Seeking: A Qualitative Study

BACKGROUND

Today, women empowering is an important issue.  Several methods have been introduced to empower women. Health information seeking is one of the most important activities in this regard. A wide range of capabilities have been reported as outcomes of health information seeking in several studies. As health information seeking is developed within personal-social interactions and also the health system context, it seems that the qualitative paradigm is appropriate to use in studies in this regard. This study aimed to explore how women's empowerment through health information seeking is done.

METHODS

In this qualitative content analysis study, data collection was done with regard to inclusion criteria, through purposive sampling by semi-structured interviews with 17 women and using documentation and field notes until data saturation. Qualitative data analysis was done constantly and simultaneous with data collection.

RESULTS

Four central themes were emerged to explain women's empowerment through health information seeking that included: a) Health concerns management with three subcategories of Better coping, Stress management, Control of situation, b) Collaborative care with two subcategories of Effective interaction with health professions and Participation in health decision making c) Individual development d) Self-protection with four sub- categories of Life style modification,  Preventive behaviors promoting, Self-care promoting, and  medication adherence.

CONCLUSION

The results of this study indicate the importance of women empowerment through foraging their health information seeking rights and comprehensive health information management.

Dr Google and the consumer: a qualitative study exploring the navigational needs and online health information-seeking behaviors of consumers with chronic health conditions

BACKGROUND

The abundance of health information available online provides consumers with greater access to information pertinent to the management of health conditions. This is particularly important given an increasing drive for consumer-focused health care models globally, especially in the management of chronic health conditions, and in recognition of challenges faced by lay consumers with finding, understanding, and acting on health information sourced online. There is a paucity of literature exploring the navigational needs of consumers with regards to accessing online health information. Further, existing interventions appear to be didactic in nature, and it is unclear whether such interventions appeal to consumers' needs.

OBJECTIVE

Our goal was to explore the navigational needs of consumers with chronic health conditions in finding online health information within the broader context of consumers' online health information-seeking behaviors. Potential barriers to online navigation were also identified.

METHODS

Semistructured interviews were conducted with adult consumers who reported using the Internet for health information and had at least one chronic health condition. Participants were recruited from nine metropolitan community pharmacies within Western Australia, as well as through various media channels. Interviews were audio-recorded, transcribed verbatim, and then imported into QSR NVivo 10. Two established approaches to thematic analysis were adopted. First, a data-driven approach was used to minimize potential bias in analysis and improve construct and criterion validity. A theory-driven approach was subsequently used to confirm themes identified by the former approach and to ensure identified themes were relevant to the objectives. Two levels of analysis were conducted for both data-driven and theory-driven approaches: manifest-level analysis, whereby face-value themes were identified, and latent-level analysis, whereby underlying concepts were identified.

RESULTS

We conducted 17 interviews, with data saturation achieved by the 14th interview. While we identified a broad range of online health information-seeking behaviors, most related to information discussed during consumer-health professional consultations such as looking for information about medication side effects. The barriers we identified included intrinsic barriers, such as limited eHealth literacy, and extrinsic barriers, such as the inconsistency of information between different online sources. The navigational needs of our participants were extrinsic in nature and included health professionals directing consumers to appropriate online resources and better filtering of online health information. Our participants' online health information-seeking behaviors, reported barriers, and navigational needs were underpinned by the themes of trust, patient activation, and relevance.

CONCLUSIONS

This study suggests that existing interventions aimed to assist consumers with navigating online health information may not be what consumers want or perceive they need. eHealth literacy and patient activation appear to be prevalent concepts in the context of consumers' online health information-seeking behaviors. Furthermore, the role for health professionals in guiding consumers to quality online health information is highlighted.

Internet use associated with HIV testing in adults in a national sample: Findings from the National Health Interview Survey, 2009

BACKGROUND

Routine Human Immunodeficiency Virus (HIV) testing is a CDC recommendation. Little is known about health information technology (HIT) use and HIV testing.

PURPOSE

To assess the relationship between HIT use and HIV screening and determine whether self-perceived HIV risk modifies this association.

METHODS

Data from the National Health Interview Survey were analyzed. The survey response rate was 65.4%. The outcome was self-report of HIV testing (Y/N). Independent variables were HIT use, self-perceived HIV risk, and socio-demographics. HIT use is defined as internet or chat room use for health information. Logistic regression tested the association between HIV testing and HIT. Crude and adjusted models are reported.

RESULTS

Of participants with data on HIV testing (n = 26,745), 40% reported being HIV tested, 52% used internet, and 4.2% used chat rooms. Internet and chat users had greater odds ratios for HIV testing (OR 1.8 95% CI (1.7, 1.9) and OR 1.7 95% CI (1.4, 2.0), respectively). Adjusting for covariates, internet use remained associated with HIV testing OR 1.4 95% CI (1.2, 1.7), but chat use did not. Self-perceived HIV risk did not modify this model.

CONCLUSION

Internet use was associated with higher odds of HIV testing in the general population. Promotion of HIV testing via online sources may benefit screening efforts.

Knowledge gaps among public librarians seeking vaccination information: A qualitative study

Public libraries have been called the "first responders" to the specialized health information needs of the general public. The challenges inherent in consumer health information (CHI) service are centered around the Patron, the Librarian, the Information Resources, and the Library itself. The pilot study involved interviews with nine individual library workers in eight public libraries in four library systems: the District of Columbia, Montgomery and Prince George's Counties in Maryland, and Fairfax County in Virginia. Library workers were asked about common consumer health information requests, the nature of their collections, and the role of public libraries in meeting these information needs. The subjects were also presented with a hypothetical scenario, and their responses suggest knowledge gaps. The findings point to the increasing necessity and importance of training and support for public librarians, as well as the importance of understanding where the medical knowledge gaps exist. Public librarians need to commit to formal evaluation of their skill sets and knowledge gaps, in order to identify areas to which libraries can devote limited resources.

Health-seeking behaviors among HIV-negative, high-risk black women living in an urban southern city

This study explores the HIV health information-seeking behavior among Black women living in a southern urban city in the United States. Interviews were conducted with 50 Black women to explore their HIV health-seeking behavior, self-efficacy, and locus of control. Results indicate that despite the multiple HIV risk factors faced by the women a majority of them did not seek out HIV health information. Policy implications for HIV prevention education are discussed.

Empowering Patients and Community Online: Evaluation of the AIDS Community Information Outreach Program

The AIDS Community Information Outreach Program (ACIOP) was created in 1994 to assist the affected community in utilizing electronic HIV/AIDS information resources. Nearly 300 competitive awards have been made to mostly community-based organizations. A formal evaluation was undertaken to determine the performance and impact of the ACIOP. A mixed methods design combined quantitative abstractions and summarization of 47 awardee final reports from 44 organizations, and qualitative telephone interviews with 17 individuals representing 20 projects. Findings revealed that project objectives were mostly met; high-risk populations were reached; low resource organizations were funded; community partnerships were significant; projects built on existing efforts; information resources and training were tailored to local needs; and most projects overcame barriers experienced. Needed modifications centered on: 1) enhancing evaluation capacity at the individual project level and 2) revising project reporting requirements to increase the amount of information available to assess the ACIOP; both have been implemented.

Factors associated with intention to use internet-based testing for sexually transmitted infections among men who have sex with men

BACKGROUND

Internet-based testing programs are being increasingly used to reduce testing barriers for individuals at higher risk of infection, yet the population impact and potential for exacerbation of existing health inequities of these programs are not well understood.

OBJECTIVE

We used a large online sample of men who have sex with men (MSM) in Canada to measure acceptability of Internet-based testing and perceived advantages and disadvantages of this testing approach.

METHODS

We asked participants of the 2011/2012 Sex Now Survey (a serial online survey of gay and bisexual men in Canada) whether they intended to use Internet-based testing and their perceived benefits and disadvantages of use. We examined whether intention to use was associated with explanatory variables spanning (A) sociodemographics, (B) Internet and technology usage, (C) sexually transmitted infections (STI)/ human immunodeficiency virus (HIV) and risk, and (D) health care access and testing, using multivariable logistic regression (variable selection using Bayesian information criterion).

RESULTS

Overall, intention to use was high (5678/7938, 71.53%) among participants with little variation by participant characteristics. In our final model, we retained the variables related to (B) Internet and technology usage: use of Internet to cruise for sex partners (adjusted odds ratio [AOR] 1.46, 95% CI 1.25-1.70), use of Internet to search for sexual health information (AOR 1.36, 95% CI 1.23-1.51), and mobile phone usage (AOR 1.19, 95% 1.13-1.24). We also retained the variables for (D) health care access and testing: not "out" to primary care provider (AOR 1.24, 95% CI 1.10-1.41), delayed/avoided testing due to privacy concerns (AOR 1.77, 95% CI 1.49-2.11), and delayed/avoided testing due to access issues (AOR 1.65, 95% CI 1.40-1.95). Finally, we retained the variable being HIV positive (AOR 0.56, 95% CI 0.46-0.68) or HIV status unknown (AOR 0.89, 95% CI 0.77-1.01), age <30 years (AOR 1.41, 95% CI 1.22-1.62), and identifying as bisexual (AOR 1.18, 95% CI 1.04-1.34) or straight/other (AOR 0.67, 95% CI 0.50-0.90). The greatest perceived benefits of Internet-based testing were privacy (2249/8388, 26.81%), general convenience (1701/8388, 20.28%), and being able to test at any time (1048/8388, 12.49%). The greatest perceived drawbacks were the inability to see a doctor or nurse (1507/8388, 17.97%), wanting to talk to someone about results (1430/8388, 17.97%), not wanting online results (1084/8388, 12.92%), and low trust (973/8388, 11.60%).

CONCLUSIONS

The high and wide-ranging intention to use that we observed suggests Internet-based testing has the potential to reach into all subgroups of MSM and may be particularly appealing to those facing current barriers to accessing STI/HIV testing and who are more comfortable with technology. These findings will be used to inform the promotion and further evaluation of an Internet-based testing program currently under development in British Columbia, Canada.

Internet search patterns of human immunodeficiency virus and the digital divide in the Russian Federation: infoveillance study

Background

Human immunodeficiency virus (HIV) is a serious health problem in the Russian Federation. However, the true scale of HIV in Russia has long been the subject of considerable debate. Using digital surveillance to monitor diseases has become increasingly popular in high income countries. But Internet users may not be representative of overall populations, and the characteristics of the Internet-using population cannot be directly ascertained from search pattern data. This exploratory infoveillance study examined if Internet search patterns can be used for disease surveillance in a large middle-income country with a dispersed population.

Objective

This study had two main objectives: (1) to validate Internet search patterns against national HIV prevalence data, and (2) to investigate the relationship between search patterns and the determinants of Internet access.

Methods

We first assessed whether online surveillance is a valid and reliable method for monitoring HIV in the Russian Federation. Yandex and Google both provided tools to study search patterns in the Russian Federation. We evaluated the relationship between both Yandex and Google aggregated search patterns and HIV prevalence in 2011 at national and regional tiers. Second, we analyzed the determinants of Internet access to determine the extent to which they explained regional variations in searches for the Russian terms for “HIV” and “AIDS”. We sought to extend understanding of the characteristics of Internet searching populations by data matching the determinants of Internet access (age, education, income, broadband access price, and urbanization ratios) and searches for the term “HIV” using principal component analysis (PCA).

Results

We found generally strong correlations between HIV prevalence and searches for the terms “HIV” and “AIDS”. National correlations for Yandex searches for “HIV” were very strongly correlated with HIV prevalence (Spearman rank-order coefficient [rs]=.881, P≤.001) and strongly correlated for “AIDS” (rs=.714, P≤.001). The strength of correlations varied across Russian regions. National correlations in Google for the term “HIV” (rs=.672, P=.004) and “AIDS” (rs=.584, P≤.001) were weaker than for Yandex. Second, we examined the relationship between the determinants of Internet access and search patterns for the term “HIV” across Russia using PCA. At the national level, we found Principal Component 1 loadings, including age (-0.56), HIV search (-0.533), and education (-0.479) contributed 32% of the variance. Principal Component 2 contributed 22% of national variance (income, -0.652 and broadband price, -0.460).

Conclusions

This study contributes to the methodological literature on search patterns in public health. Based on our preliminary research, we suggest that PCA may be used to evaluate the relationship between the determinants of Internet access and searches for health problems beyond high-income countries. We believe it is in middle-income countries that search methods can make the greatest contribution to public health.

An Ecological View of Internet Health Information Seeking Behavior Predictors: Findings from the CHAIN Study

Objective:

The purpose of the study was to further elucidate proximal and distal demographic and social predictors of Internet Health Information Seeking Behavior (IHISB) among a cohort of HIV+ individuals through an ecological framework.

Methods:

The Community Health Advisory & Information Network (CHAIN) project is an ongoing prospective study of a representative sample of persons living with HIV/AIDS in New York City and the Tri-County region. The study sample was drawn from a two-stage randomized technique with the clients of 43 medical and social service organizations with 693 HIV+ participants. Bivariate correlations were computed between IHISB and independent demographic variables in ecological blocks. Multivariate hierarchical logistic regression was used to test association between blocks of variables and IHISB.

Results:

Among the surveyed respondents (n=645) 50.3% indicated that they used the Internet. Being above the poverty line, having less than a high school education, and having fewer neighbors were statistically significant predictors of IHISB related to HIV.

Conclusions:

The benefits of accessing the Internet may influence health behavior and may be considered a target for interventions that aim to increase access to health related information online. Coupled with increased access, is the need for increased patient education interventions, and creative managed care approaches to ensure that information gleaned from online sources is interpretable and accurate in order to benefit the lives of those living with HIV/AIDS.