Everyday health and the internet: a mediated health perspective on health information seeking

Internet use among persons with common mental disorders: A qualitative study

Aims and Objectives

To assess the current patterns and experience of internet use among persons with depressive and anxiety disorders, particularly for health-related issues.

Methodology

In-depth interviews were conducted with persons diagnosed with depressive and anxiety disorders (DSM-5), aged ≥18 years who could read and write in Hindi/English, using an interview guide. The interview guide contained questions related to internet use in daily life, internet use for health-related issues, and internet use for stress, and internet use for anxiety/depressive disorder. Interview data were transcribed and analyzed to identify codes and subsequently themes.

Results

A total of 20 subjects; 10 each diagnosed with depressive and anxiety disorders were interviewed. About half the participants could operate internet independently, while rest required assistance. YouTube was the most common search engine used, and leisure was the most common reason for daily use. Almost all participants reported searching internet for health-related information including their psychiatric diagnosis. The most common purpose, for health in-general, was searching for alternate therapies. Most common purpose for psychiatric diagnosis was understanding the symptoms, recovery from their illness, and side effects of medicines. Highest impact as perceived by the participants was on distraction or stress reduction rather than direct impact on the illness/treatment.

Conclusion

Persons with depressive and anxiety disorders use internet for distraction, communication, and seeking information about the illness and medicines.

Exploring the health information seeking behavior of social media users under the background of COVID-19 pandemic: An empirical study based on social cognitive theory

With the outbreak of COVID-19 in late 2019, people's awareness of actively searching for health information has been growing. Coupled with the promotion of "Internet + medical and health," social media, as an important platform for health information dissemination, has become one of the important information sources for users to obtain health information. However, health information seeking behavior in public health emergencies are quite different from those in daily life. Therefore, the research question of this paper is to explore the influencing factors of health information seeking behavior of social media users in the context of COVID-19. To this end, based on the research framework of social cognition theory, this paper selects six variables to construct a structural equation modeling, including information and platform quality, experience, social support, emotional arousal, self-efficacy, and social media users' health information seeking behavior. The empirical study is carried out by collecting 219 valid questionnaires. The research results show that: (1) Information and platform quality, and use experience have a significant positive effect on emotional arousal; (2) Experience, social support, and emotional arousal have a significant positive effect on self-efficacy; (3) Emotional arousal and self-efficacy have a significant positive effect on social media users' health information seeking behavior. The research provides an important theoretical reference for social media users and operators to cope with the huge demand for health information in the post-COVID-19 era.

"You become a slightly better doctor": Doctors adopting integrated medical expertise through interactions with E-patients

The accessibility of information via the internet has radically altered the doctor-patient relationship. By means of in-depth interviews with Israeli physicians from four different specialties, this study explored how physicians cope with internet-informed patients, referred to as e-patients, and examined how they make sense of their new professional roles. Findings show that three types of boundaries in the doctor-patient relationship have been blurred by the emergence of the e-patient: the boundaries between doctors' and patients' knowledge, between doctors' authority and patients' autonomy, and between positivistic knowledge and humanistic knowledge. Each of these is a boundary between liberal and non-liberal values. Only the combination of all these components produces, according to the participants, a good doctor. I call this new phenomenon integrated medical expertise and explain how it diverges from previous notions of 'good doctoring'.

Spanish-Language News Consumption and Latino Reactions to COVID-19

While the literature on infectious disease outbreaks has examined the extent to which communication inequalities during public health emergencies exacerbate negative outcomes among disadvantaged individuals, the implications of ethnic media consumption among minority groups during these crises are underexplored. Making use of the first nationally representative survey of US Latinos (N = 1200) on the impact and reactions to COVID-19, this study examines the implications of Spanish-language news media consumption on source credibility and attitude formation during the COVID-19 pandemic among Latinos and immigrants from Latin America. Through a series of statistical analyses, this study finds that ethnic news consumption is strongly associated with trust in Spanish-language journalists, whereas mainstream media consumption is not associated with trust in English-language journalists. More importantly, this study finds that source credibility, particularly in Spanish-language journalists, matters for Latinos as it is associated with more positive assessments of state and local officials providing adequate information about COVID-19. This study illuminates the importance of non-traditional media among racial minorities, who account for almost 40% of the US population, and highlights the importance of shared backgrounds in source credibility among linguistically diverse groups in the United States during a public health crisis.

"No one associates alcohol with being in good health": Health and wellbeing as imperatives to manage alcohol use for young people

Young people's drinking has declined markedly in Australia over the past 15 years, and this may be linked to changing norms and values around health. We take the view that healthism-a discourse that privileges good health and renders people personally responsible for managing health-has become pervasive, creating new pressures influencing young people's alcohol practices. Through interviews with 50 young light drinkers and abstainers, we explored these notions of health and alcohol. Although health was not the only reason that participants abstained or drank lightly, many avoided drinking to minimise health risks and to pursue healthy lifestyles. Their understanding of health came from multiple sources such as the media, schools, parents-and often reinforced public health messages, and healthist discourse. This discourse influenced how participants perceived health norms, engaged with health in everyday life and managed their alcohol consumption. Because the need to be healthy incorporated bodily health, mental health and social wellbeing, it also created tensions around how young people could drink while maintaining their health. This highlights the importance of health as a key consideration in the alcohol practices of light drinking and abstaining young Australians, which could help explain broader declines in youth drinking.

'I don't know if we can really, really change that': a qualitative exploration of public perception towards antibiotic resistance in France

Background

Since the 2000s, French authorities have put in place various national plans to make the general public aware of antibiotic stewardship. Twenty years later, France is still one of the countries with the highest use of antibiotics in Europe.

Objectives

Our study explored the general public’s perceptions of antibiotic resistance, their behaviour around antibiotic use and their expectations regarding awareness campaigns.

Methods

A qualitative study was performed from March 2018 to March 2019 in a French region using focus groups. Two types of public were targeted: parents of young children and retired people. The interview guide contained open-ended questions organized around three main themes: perceptions of antibiotic resistance; experience and use of antibiotics; and health information and campaigns.

Results

Nine focus groups were created, including 17 parents and 19 retirees. Participants did not link antibiotic overuse and antibiotic resistance. Antibiotic resistance was not perceived as a personal responsibility but as a suffered phenomenon on which the participants could not act. The blame was particularly put on the presence of antibiotics in the environment. Although participants expressed trust in their GPs, antibiotics remained perceived as the only solution for them to be cured quickly.

Conclusions

The study highlighted that the GPs were the preferred information source regarding the use of antibiotics. Actions targeting the public and health professionals will have little impact if, at the same time, efforts on work environment representation are not undertaken.

Morbid curiosity? Discussion of the disposal of amputated limbs on online question and answer sites

Amputation is a growing health issue with implications for the corporeal form and sense of bodily identity. Disposal of the removed limb (the amputate) has historically been suggested to impact on patient adaptation to amputation, although understandings of limb disposal are scarce within existing research. The growth of online question and answer sites has created opportunities for social actors to post and respond to a vast array of topic areas, including those that are seen as morbid or taboo. This paper then explores the discussion of amputate disposal within threads from two popular question and answer sites. Using thematic analysis, the paper examines how perceived ownership of limbs, understanding of the amputate as ‘waste’ and recourse to grotesque humour are key means by which limb disposal is discussed within these sites. Posters then create a new knowledge around the disposal of limbs, albeit one framed by uncertainty.

Health literacy and quality of life in patients with treatment-resistant epilepsy

This exploratory study examined the impact of health literacy on quality of life (QoL) in patients with treatment-resistant epilepsy (TRE). Health literacy is a discrete form of literacy in which an individual can readily interpret prose and apply that skill to understand medical, pharmaceutical, and self-management information. From the perspectives of cultural health capital (CHC) and social disability theory, we hypothesized that greater levels of health literacy would be associated with a higher QoL score. The sample (n = 79) included adult patients with TRE enrolled in the University of Alabama at Birmingham Cannabidiol Program. The data were analyzed by using nested linear regression. Respondents aged 19-63 years (mean, standard deviation [SD] = 32.9 [13.65]) and were 92% white; 44% of patients were in Special Education until age 21 years, and 29% reported a total annual family income of less than $25,000. Significant bivariate relationships were found between health literacy and QoL (p = .004), age (p = .0001), and income (p = .036). There was a significant difference in health literacy scores for patients who completed high school or less (mean [SD] = 0.68 [0.86]) and those with any postsecondary education (mean [SD] = 1.59 [1.0]). The regression results showed health literacy to be positively associated with QoL where a 1% increase in health literacy was associated with a 6.61-point increase in QoL (p = .004), and this pattern persisted through each addition of other independent factors and control variables. This is one of the first studies investigating the role of health literacy in QoL among patients with TRE. The results suggest that health literacy is important and may function as a tool through which healthcare participation is expanded. Further research is needed with larger, more diverse, and longitudinal samples to accurately model the development of health literacy and its impact on QoL in this population.

The vaccination debate in the "post-truth" era: social media as sites of multi-layered reflexivity

This paper analyses the contemporary public debate about vaccination, and medical knowledge more broadly, in the context of social media. The study is focused on the massive online debate prompted by the Facebook status of the digital celebrity Mark Zuckerberg, who posted a picture of his two-month-old daughter, accompanied by a comment: 'Doctor's visit - time for vaccines!' Carrying out a qualitative analysis on a sample of 650 comments and replies, selected through systematic random sampling from an initial pool of over 10,000 user contributions, and utilising open and axial coding, we empirically inform the theoretical discussion around the concept of the reflexive patient and introduce the notion of multi-layered reflexivity. We argue that the reflexive debate surrounding this primarily medical problem is influenced by both biomedical and social scientific knowledge. Lay actors therefore discuss not only vaccination, but also its political and economic aspects as well as the post-truth information context of the debate. We stress that the reflexivity of social actors related to the post-truth era re-enters and influences the debate more than ever. Furthermore, we suggest that the interconnection of different layers of reflexivity can either reinforce certainty or deepen the ambiguity and uncertainty of reflexive agents.

Understanding digital health: Productive tensions at the intersection of sociology of health and science and technology studies

In this editorial introduction, we explore how digital health is being explored at the intersection of sociology of health and science and technology studies (STS). We suggest that socio-material approaches and practice theories provide a shared space within which productive tensions between sociology of health and STS can continue. These tensions emerge around the long-standing challenges of avoiding technological determinism while maintaining a clear focus on the materiality and agency of technologies and recognising enduring sets of relations that emerge in new digital health practices while avoiding social determinism. The papers in this Special Issue explore diverse fields of healthcare (e.g. reproductive health, primary care, diabetes management, mental health) within which heterogenous technologies (e.g. health apps, mobile platforms, smart textiles, time-lapse imaging) are becoming increasingly embedded. By synthesising the main arguments and contributions in each paper, we elaborate on four key dimensions within which digital technologies create ambivalence and (re)configure health practices. First, promissory digital health highlights contradictory virtues within discourses that configure digital health. Second, (re)configuring knowledge outlines ambivalences of navigating new information environments and handling quantified data. Third, (re)configuring connectivity explores the relationships that evolve through digital networks. Fourth, (re)configuring control explores how new forms of power are inscribed and handled within algorithmic decision-making in health. We argue that these dimensions offer fruitful perspectives along which digital health can be explored across a range of technologies and health practices. We conclude by highlighting applications, methods and dimensions of digital health that require further research.

Internet Use and Preventive Health Behaviors Among Couples in Later Life: Evidence from the Health and Retirement Study

Background and Objectives

The aim of this study was to examine the link between internet use and preventive health behaviors. We focused on couples to examine whether there were cross-partner associations between internet use and preventive health behaviors.

Research Design and Methods

The data for this study came from the 2010 and 2012 waves of the Health and Retirement Study and the sample consisted of 5,143 pairs of coupled-individuals. Preventive health behaviors included cancer screenings (mammogram and prostate tests), cholesterol tests, and flu shots. Logistic multilevel actor-partner interdependence models were employed to test the study hypotheses.

Results

Internet use was associated with a higher likelihood of receiving prostate exams and cholesterol tests for husbands, net of demographic and health characteristics, and insurance status. We found that wives' internet use was associated with a higher likelihood of receiving flu shots and prostate exams for husbands, but husbands' internet use was not associated with wives' preventive health behaviors.

Discussion and Implications

Research linking internet use and preventive health behaviors is important because such behaviors are associated not only with health of the older population but also with substantial reductions in health care expenditures. Our findings suggested that internet use of older adults is associated with their own preventive health behaviors, as well as their spouses' preventive health behaviors. Interventions and programs to facilitate older adults' preventive health behaviors should consider couple-based approaches.

Pregnant with possibility: The importance of visual data in (re)presenting queer women’s experiences of reproduction

In this article, I discuss a queer method for uniting visual sociology, digital sociology, and constructivist grounded theory to conduct innovative research into how lesbian couples experience the transition to first-time parenthood, based on my longitudinal doctoral research in sociology. I first attend to the complex and unexpected unfolding of the research design, which evolved with the needs of the population to move from adapted photovoice interviews to the use of textual–visual online pregnancy journal data in a process emblematic of queer methodology. I then consider the contributions that visual data can make to the study of reproduction, especially where marginalized populations are concerned, by using my data to demonstrate how visuals create what is possible, rework oppressive versions of time, and challenge controlling images imposed on reproducing bodies. I argue here not just for the significance of images but for the significance of taking seriously the products and processes that communities find meaningful, and for evolving our research methods and methodologies to centralize marginalized ways of existing, knowing, and archiving experiences of reproduction and family life.

Characterizing the Digital Health Citizen: Mixed-Methods Study Deriving a New Typology

Background

A key challenge for health systems harnessing digital tools and services is that of digital inclusion. Typically, digital inequalities are conceptualized in relation to unequal access or usage. However, these differences do not fully explain differences in health behavior as a result of health-related internet use.

Objective

Our objective was to derive a new typology of health internet users based on their antecedent motivations and enablers, to explain how individuals’ different orientations influence their health behavior.

Methods

We used a mixed-methods design using (1) qualitative data from 43 semistructured interviews about individuals’ general and health-related internet use, and how this influenced their health perception and their help-seeking decisions, and (2) quantitative data from the Oxford Internet Surveys (OxIS), a household survey of 2150 adults in England about their internet use and other characteristics. We used the interview data to identify constructs that described motivations and enablers affecting how internet use shaped respondents’ health perception and health service use. We then used these constructs to identify variables in OxIS, which provided a quantitative measure of these constructs. We then undertook a hierarchical cluster analysis of these constructs, using the numerical variables, to derive a proposed typology of health information seekers.

Results

Both the qualitative findings and the subsequent cluster analysis suggested the existence of 6 types of individuals, categorized as learners, pragmatists, skeptics, worriers, delegators, and adigitals. Learners had a strong desire to understand health better. They used the internet to make decisions about whether they needed to see a professional and to learn about their and others’ health. Pragmatists primarily used the internet to decide whether seeing a doctor was worthwhile. Skeptics were skeptical of physicians and the medical system and valued the internet for solving health problems that doctors may not be able to deal with. Worriers found it difficult to interpret health information online, described health information seeking online as frightening, and reported a critical attitude toward online health information despite seeking it frequently. Delegators comprised nonusers and users valuing the internet as an information source, but not necessarily wanting or being able to use the internet themselves. Adigitals comprised many nonusers, but also users, who did not see the internet as a useful information tool and presented strong views on its low suitability for health care.

Conclusions

This research supports a shift in the understanding of the digital divide in health, away from only access and usage issues, toward also conceptualizing an outcomes divide, whereby different types of health behavior result from the differing orientations of internet users accessing online health information. This new typology can be used to inform digital inclusion policies in health systems.

[Health literacy profiles in type 2 diabetes: The ERMIES-Ethnosocio study]

INTRODUCTION

Health literacy refers to the competences and resources required by individuals to meet the complex demands of health in modern society. This paper describes and analyses the health literacy profiles of type 2 diabetic patients included in a 2-year long self-management education programme.

METHODS

Nested in the ERMIES randomized controlled trial conducted in Reunion island, the ERMIES Ethnosocio study explored health literacy by means of two complementary approaches: description of health literacy profiles via the French version of the multidimensional "Health Literacy Questionnaire", and a socio-anthropological perspective based on 40 semi-structured interviews carried out in 2012 and then in 2015.

RESULTS

The results highlight the existence of 8 constitutive variables in the management of type 2 diabetes in an ordinary context: diet, physical activity, treatment and monitoring of disease (disease management), access to knowledge and skills (health knowledge), relationships with health professionals and social support (expertise, support and social network). They also emphasize the differentiated relationships of individuals to each of these variables, ranging from functional to interactive or critical "levels".

DISCUSSION

Considering the development of health literacy with patients and health professionals, and by questioning educational and therapeutic interventions as differentiating processes, this research opens up new perspectives for the approach to social inequalities in health. The combination of social sciences, medical sciences and public health is proving fruitful and potentially operative, provided that the definitions, methods, and strengths and limitations of selected prospects are clearly defined.

Consumer evaluation of 'Veggycation®', a website promoting the health benefits of vegetables

Issue addressed Whether the website Veggycation^® appeals to particular groups of consumers significantly more than other groups. Methods Australian adults aged ≥18 years (n = 1000) completed an online survey. The website evaluation instrument used was tested for validity and reliability. Associations between demographic variables and website evaluation dimensions of attractiveness, content, user-friendliness and loyalty intentions were examined using a general linear model (GLM). The appraisal of the website was further investigated based on the respondents' daily consumption level of vegetables and the importance they attach to vegetable consumption in their diet, using GLM and a Tukey's all-pair comparison. Results Veggycation^® has a high level of acceptance among the Australian community with certain groups evaluating the website more favourably. These include women, people aged≤29 years, higher income respondents, non-metro respondents and those who viewed vegetables as extremely important in their daily diet. Conclusions Customisation of the website for consumer groups with low vegetable consumption is recommended. Designing tailored communication tools will assist in enhancing the knowledge base of vegetable-related health benefits and may promote vegetable consumption among the Australian population. So what? The promotion of higher vegetable consumption is aided by tailored, well-designed web communication. This study adds to the existing body of knowledge for the education of organisations developing e-tools for promoting health education and literacy.

Constructing queer mother-knowledge and negotiating medical authority in online lesbian pregnancy journals

Medical interactions around reproduction are increasingly extending beyond the physician's office and onto the Internet, where negotiation with medical authority occurs in complex and dynamic ways. Recently, scholars have noted the Internet's potential for creating spaces where women can dialogue with and reconstruct medical authority, yet this growing body of work is overwhelming heteronormative. This paper thus interrogates how lesbian women use the Internet to challenge, deploy, and rework medical authority around reproduction while navigating the transition to parenthood. I draw from 17 online journals authored by lesbian couples during the conception, pregnancy, and birth of their first child, each spanning between 18 months and 2 years, in order to understand how the transition process unfolds over time. I argue that lesbian couples engage with medical authority when seeking affirmation and normalisation yet discard and publicly reject the heteronormative assumptions that accompany reproductive medicine. Further, they chart a new process that I term 'constructing queer mother-knowledge', in which they critique and balance knowledges from institutionalised medicine, their own bodies, and their queer communities. With this new concept, I complicate understandings of lesbian mothers-to-be and their interactions with medical authority as they build subversive families.

Characterisation of health literacy strengths and weaknesses among people at metabolic and cardiovascular risk: Validity testing of the Health Literacy Questionnaire

Objectives:

Health literacy refers to the ability of individuals to gain access to, use, and understand health information and services in order to maintain a good health. The assessment of health literacy profiles in a population is potentially crucial to respond to health needs. The Health Literacy Questionnaire explores nine dimensions of health literacy and has been shown to display robust psychometric properties. The aim was to test the validity of the multidimensional Health Literacy Questionnaire and to describe the health literacy profiles in a French population at risk of cardiovascular disease.

Methods:

Data were collected using self-administered questionnaires from 175 participants attending health education and support programmes in local associations of patients in Paris. Analysis included scale reliability, confirmatory factor analysis, and health literacy profiles via descriptive statistics.

Results:

In confirmatory factor analysis, the nine-factor structure was close to the original Health Literacy Questionnaire. A nine-factor confirmatory factor analysis model was fitted to the 44 items with no cross-loadings or correlated residuals allowed. Given the restricted nature of the model, the fit was satisfactory: χ²_WLSMV(866 df) = 1383.81, p = 0.0000, comparative fit index = 0.925, Tucker–Lewis index = 0.918, root mean square error of approximation = 0.058, weighted root mean square residual = 1.175. Composite reliability ranged from 0.77 to 0.91. Among the 9 scales of the Health Literacy Questionnaire, the highest scores were found for scale 1 ‘Feeling understood and supported by healthcare professionals’ and scale 9 ‘Understand health information enough to know what to do’ and the lowest for scale 2 ‘Having sufficient information to manage my health’ and scale 7 ‘Navigating the healthcare system’.

Conclusion:

The French version of the Health Literacy Questionnaire was shown to be psychometrically robust with good reliability. In the context of France, the 9 scales of Health Literacy Questionnaire allow a thorough assessment of health literacy strengths and weaknesses to respond to health literacy needs and improve the accessibility of health information and services.

Resolving embarrassing medical conditions with online health information

PURPOSE

Reliance on online health information is proliferating and the Internet has the potential to revolutionize the provision of public health information. The anonymity of online health information may be particularly appealing to people seeking advice on 'embarrassing' health problems. The purpose of this study was to investigate (1) whether data generated by the embarrassingproblems.com health information site showed any temporal patterns in problem resolution, and (2) whether successful resolution of a medical problem using online information varied with the type of medical problem.

METHODS

We analyzed the responses of visitors to the embarrassingproblems.com website on the resolution of their problems. The dataset comprised 100,561 responses to information provided on 77 different embarrassing problems grouped into 9 classes of medical problem over an 82-month period. Data were analyzed with a Bernoulli Generalized Linear Model using Bayesian inference.

RESULTS

We detected a statistically important interaction between embarrassing problem type and the time period in which data were collected, with an improvement in problem resolution over time for all of the classes of medical problem on the website but with a lower rate of increase in resolution for urinary health problems and medical problems associated with the mouth and face. As far as we are aware, this is the first analysis of data of this nature.

CONCLUSIONS

Findings support the growing recognition that online health information can contribute to the resolution of embarrassing medical problems, but demonstrate that outcomes may vary with medical problem type. The results indicate that building data collection into online information provision can help to refine and focus health information for online users.

Using eHealth to Increase Autonomy Supportive Care: A Multicenter Intervention Study in Antenatal Care

eHealth solutions are increasingly implemented in antenatal care to enhance women's involvement. The main aim of this study was to evaluate women's assessment of autonomy supportive care during the antenatal care visits among low-risk pregnant women. An intervention study was conducted including a control group attending standard antenatal care and an intervention group having access to an eHealth knowledge base, in addition to standard care. A total of 87 women were included in the control group and a total of 121 women in the intervention group. Data were collected using an online questionnaire 2 weeks after participants had given birth. Data were analyzed using χ tests and Wilcoxon rank sums. Use of an eHealth knowledge base was associated with statistically significant higher scores for women's overall assessment of antenatal care visits, the organization of antenatal care visits, confidence after antenatal care visits, and involvement during antenatal care visits. We also found a statistically significant higher overall self-perceived autonomy supportive care in the intervention group compared with the control group.

"That Should Be Left to Doctors, That's What They are There For!"-Exploring the Reflexivity and Trust of Young Adults When Seeking Health Information

This paper explores the health information-seeking practices of healthy young adults and how they assess and rank sources of information through a qualitative study. The findings show that participants (a) are strongly committed to searching for information about health and lifestyle, especially via the Internet; (b) healthcare professionals were perceived as the most reliable source of health information and advice; (c) online health information, although frequently accessed and experienced as empowering, is seen as a potentially unreliable source. Findings evidence how becoming better informed about health-related topics plays a pivotal role in individuals' lives, most notably by using the Internet. Participants were able to reflect about what it means to know about health. The construction of trust regarding health information involved a heuristic process vis-à-vis source reliability and perceived credibility that places doctors as the most trustworthy medium of medical advice and health information. We conclude that participants' trust toward professionals suggests the preference and need for more personalized care; and it is a response to the ambiguity and uncertainty that permeates the health information landscape, particularly that which is web-based.

Students Seeking Health-related Information over Internet

The use of Internet to search information related to health has become a common phenomenon. This article investigates the seeking of health-related information of the college going students over the Internet. The researchers have tested the technology acceptance model (TAM) to determine the behavioural intention of the students to seek health-related information over the Internet. A self-administered questionnaire was distributed among the students who were involved in Internet use. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied to the responded data. The results showed that it is the perceived usefulness (PU) which has a direct impact on the behavioural intention of the Internet users to search health-related information over the Internet.

Co-constructed health narratives during a 'media event': The case of the first Dutch Twitter heart operation

OBJECTIVE

This article examines the relationship between microblogging and the development of health narrative through the lens of an institution-initiated media event, the first live-tweeted heart operation in the Netherlands. It specifically addresses the question, how does health narrative take shape on a microblog and other (social) media, through the combination of self-initiated status updates, reactions to questions and short conversations with followers?

METHODS

A combination of qualitative and quantitative data analysis was used to identify prominent themes in the tweets and trace the complex process by which the narrative took shape. The results presented here are derived from the qualitative analysis.

RESULTS

There are four recurring health narrative themes in the tweets: (a) new challenges to professionalism; (b) mutual exchanges of information, support and advice; (c) increasingly personal (and public) details; and (d) questions about 'resuming normalcy'. The special nature of this case also reveals interesting features, such as the multiple narrative starting points and the phenomenon of 'tweeting by proxy', and raises a number of critical questions regarding this type of use of social media in healthcare.

CONCLUSIONS

In the discussion we reflect on whether/how microblogged health narratives are really 'new' and on the implications of this single case for understanding the relationship between social media, health narrative and the changing relationships between information technologies, actors and institutions. We further examine this case as an example of what Lupton has deemed the 'digital patient experience economy', in reference to patients increasingly being encouraged to post experiences of their illness and encounters with the healthcare system to online platforms, where these shared experiences become valorised and monetised.

Young adults' experiences of seeking online information about diabetes and mental health in the age of social media

BACKGROUND

The Internet is a primary source of health information for many. Since the widespread adoption of social media, user-generated health-related content has proliferated, particularly around long-term health issues such as diabetes and common mental health disorders (CMHDs).

OBJECTIVE

To explore perceptions and experiences of engaging with health information online in a sample of young adults familiar with social media environments and variously engaged in consuming user-generated content.

METHODS

Forty semi-structured interviews were conducted with young adults, aged 18-30, with experience of diabetes or CMHDs. Data were analysed following a thematic networks approach to explore key themes around online information-seeking and content consumption practices.

RESULTS

Although participants primarily discussed well-rehearsed approaches to health information-seeking online, particularly reliance on search engines, their accounts also reflected active engagement with health-related content on social media sites. Navigating between professionally produced websites and user-generated content, many of the young adults seemed to appreciate different forms of health knowledge emanating from varied sources. Participants described negotiating health content based on social media practices and features and assessing content heuristically. Some also discussed habitual consumption of content related to their condition as integrated into their everyday social media use.

CONCLUSION

Technologies such as Facebook, Twitter and YouTube offer opportunities to consume and assess content which users deem relevant and useful. As users and organizations continue to colonize social media platforms, opportunities are increasing for health communication and intervention. However, how such innovations are adopted is dependent on their alignment with users' expectations and consumption practices.

"You get to know the people and whether they're talking sense or not": Negotiating trust on health-related forums

The internet is increasingly being used as a source of health advice and information by individuals with long term conditions (LTCs). Specifically, online forums allow people to interact with others with similar conditions. However, it is not clear how online health information is assessed by those with LTCs. This study aims to address this gap by exploring how individuals with contested and uncontested LTCs utilise internet forums. Semi-structured interviews were conducted with 20 participants with ME/CFS and 21 participants with type 1 and 2 diabetes and analysed using thematic analysis. Participants were recruited via online and offline routes, namely forums, email lists, newsletters, and face-to-face support groups. The findings indicate that the use of online forums was a complex and nuanced process and was influenced by a number of individual and illness-specific factors. Participants trusted those with similar experiences and perspectives as themselves, while also valuing conventional biomedical information and advice. By accessing support online, forum users were able to draw on a personalised form of support based on the lived experiences of their peers. However, the role of digital literacy in developing and maintaining online relationships must be acknowledged.

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The use of online forums by individuals with LTCs is a complex and nuanced process.

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Participants trust those with similar experiences and perspectives as themselves.

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Users can access a personalised form of support based on the experiences of peers.

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Role of digital literacy in developing online relationships must be acknowledged.

Health information seeking of low socioeconomic status Hispanic adults using smartphones

Purpose

– Smartphones have great potential to bridge the digital divide that low-socioeconomic status (SES) Hispanics have been experiencing. However, little is known about this group’s use of smartphones for health information. The purpose of this paper is to fill the gap by exploring the context in which smartphones were used for health information.

Design/methodology/approach

– The authors interviewed 20 low-SES Hispanic participants using the semi-structured interview method. Participants had not obtained college degrees and had annual incomes less than $30,000, but had used their smartphones for health information. The interviews were transcribed and analyzed using the qualitative content analysis method.

Findings

– Being economical was an important reason for low-SES Hispanic users to use smartphones for health information. The users relied heavily on public Wi-Fi to access the internet. They searched a wide range of health topics, mostly using the mobile web rather than apps. They lacked knowledge and skills to effectively using apps, evaluating the quality of health information, and comprehend information.

Research limitations/implications

– Having access to smartphones alone does not help bridge the digital gap for low-SES Hispanics. Interventions need to consider improving these users’ smartphone literacy and health literacy, as well as improving their access to Wi-Fi services and to more quality content in Spanish.

Originality/value

– Prior studies speculated that smartphones could be a means to bridge digital divide experienced by the Hispanic ethnic group. This study provided empirical knowledge about how smartphones are used by these users for health information, and shed light on the design of future informational interventions.

Pediatric cancer and the internet: exploring the gap in doctor-parents communication

The aim of this study is to examine the use of the Internet to obtain information by parents of children with cancer and how pediatric oncologists understand this new scenario and the shifting relationship between patients and doctors. With this goal in mind, we conducted two surveys: one was answered by 110 parents of pediatric cancer patients and another one was answered by 74 oncologists, members of the Spanish Society of Pediatric Hematology and Oncology (SEHOP). Less than half of the surveyed parents (44.5%) looked for information on the Internet, while 55.5% preferred not to do it. In addition, 87.3% of the parents explain that their doctors did not recommend any Internet resources. Among the oncologists' sample, 68.9% of the respondents did not recommend seeking information on the Internet, but they would consider it desirable for the patients to be guided in the search (82.4%). These results show some degree of dissent between the parents' needs and the oncologists' attitudes. Higher interaction between these two agents would be recommended in order to achieve better information and cooperation in the therapeutic protocols.

Communal normalization in an online self-help group for adolescents with a mentally ill parent

Although implications of parental mental illness are well documented, most children of mentally ill parents are left to manage their family situation with limited information and support. We explored the role of a Norwegian online self-help group for adolescents (aged 15 to 18) with a mentally ill parent. Through in-depth interviews with 13 participants, we found that the online self-help group provided "communal normalization" by which participants, through communication in the forum, made sense of everyday experiences and emotions arising from having a mentally ill parent. We identified three main aspects of this process-recognizability, openness, and agency-all of which were important for the adolescents' efforts to obtain support, to be supportive, and to handle everyday life situations better. Communal normalization might provide resources for significantly improving the participants' life situations, and could demonstrate similar potential for users in other situations characterized by stigma, loneliness, silence, and health worries.

Physician's emerging roles relating to trends in health information technology

OBJECTIVE

To determine the new roles that physicians will adopt in the near future to adjust to accelerating trends from managed care to outcome-based practice to health care reform to health information technology to the evolving role of health consumers.

METHODS

Trends and related developments concerning the changing roles of physicians based on prior literature reviews.

RESULTS

Six possible roles, traditional, gatekeeper, coach, navigator, informatician and one voice among many, are discussed in terms of physician's centrality, patient autonomy, decision-making and uncertainty, information seeking, satisfaction and outcomes, particularly those related to compliance.

CONCLUSION

A greater understanding of these emerging roles could lead to more efficacious outcomes in our ever changing, increasingly complex medical system. Patients often have little understanding of emerging trends that lead to the development of specialized roles such as hospitalist and navigators and, relatedly, the evolving roles of physicians.

"I think about Oprah": social class differences in sources of health information

Health information influences an individual's health outcomes. Indeed, researchers have found that communication inequalities contribute to health inequalities. We do not have a clear understanding of why and how the communication disparities exist, however, particularly the social forces behind such differences. The qualitative nature of this article reveals the nuances of health information seeking using the case of infertility. Through 58 in-depth interviews, I demonstrate how differences in social and cultural capital between women of low and high socioeconomic status (SES) result in different ways of learning about health. Women of high SES have access to support groups, physicians, and the Internet, whereas women of low SES do not discuss their health problems with their peers, and lack access to and distrust physicians. I explore how these differences in health information shape the illness experience. I conclude with policy implications.

The devil you know: parents seeking information online for paediatric cancer

There is a growing interest in understanding the effect that online information-seeking has on patients' experiences, empowerment and interactions with healthcare providers. This mixed-methods study combines surveys and in-depth interviews with 41 parents of paediatric cancer patients in the USA to examine how parents think about, evaluate, access and use the internet to seek information related to their child's cancer. We find that, during the acute crisis of a child being diagnosed with cancer, parents preferred to receive information related to their child's diagnosis, prognosis and treatment options from a trusted healthcare provider rather than through the internet. We find that access to medically related cancer information through the internet was deemed to be untrustworthy and frightening. Parents' reasons for avoiding online information-seeking included fear of what they might find out, uncertainty about the accuracy of information online, being overloaded by the volume of information online and having been told not to go online by oncologists. Some parents also had logistical barriers to accessing the internet. While most parents did not turn to the internet as a source of health-related information, many did use it to connect with sources of social support throughout their child's illness.

Enterprising or altruistic selves? Making up research subjects in genetics research

The emergence of direct-to-consumer (DTC) personal genomics companies in 2007 was accompanied by considerable media attention and criticism from clinical geneticists and other health professionals, regulators, policy advisors, and ethicists. As well as offering genetic testing services, some firms are also engaged in building their own databases and conducting research with the data obtained from their customers. In this paper, we examine how one of these companies, 23andMe, is creating a certain kind of 'research subject' in opposition to that constituted in conventional forms of disease research. Drawing on debates about neoliberalism, contemporary health discourses and subjectivity, we consider two kinds of subjectivities produced through the discursive and material practices of 23andMe and UK Biobank, namely, 'enterprising' and 'altruistic' selves. We argue that the 23andMe model promotes the idea that curiosity about one's genome on the one hand, and participation in research on the other, are not only compatible but complementary aspects of being an entrepreneurial subject of contemporary health and medicine framed by the technologies of web 2.0.

Quality assurance of nursing web sites: development and implications of the ALEU method

This article presents a study that evaluated the physical accessibility, readability, and usability of Spanish nursing Web sites and discusses the quality assurance issues raised, which are relevant to the wider nursing community. The Internet is recognized as an important source of health information for both nurses and the general public. Although it makes health-related information universally available, the wide variation in the overall quality of health Web sites is problematic. This raises many questions for the nursing profession: about what constitutes a good-quality Web site, about the nature of the information that nurses are finding and using to support their professional education, research, and clinical practice, and about the impact that Internet information ultimately has on health interactions and nursing care. The process of completing this small study showed that it is possible to usefully assess dimensions of Web site quality and suggested that it may be feasible to develop tools to help nurses evaluate national and international nursing Web sites. More research is needed to understand how nurses use the Internet to support their everyday professional practices, but the development and application of international Web site quality assurance tools may be important for maintaining professional nursing standards in the Internet age.

The public and the Internet: multifaceted drives for seeking health information

The aim of this study was to gain insight into people's drives, or motives, for seeking health information on the Internet. A systematic literature review, restricted to handbooks and reviews, was conducted by searching the databases of various disciplines. Each drive was translated into the context of health information. Five drives were retrieved from the fields of psychology, mass communication, library and information science, and medical science: drives regarding the retrieval of knowledge, social contact or support, tempering uncertainty, entertainment, and self-actualization. Based on these results, three hypotheses were generated for future research: (1) drives are interconnected and may be present simultaneously in the process of seeking information; (2) they not only serve as antecedents for the need for information, but are present throughout the entire information-seeking process; (3) they are subject to change throughout the information-seeking process. Various drives play a role in the health information-seeking process.

Managing 'difficult emotions' and family life: exploring insights and social support within online self-management training

BACKGROUND

Previous research has demonstrated how the Internet can foster emotional support and provide a 'private' space for discussing sensitive issues. Whilst the family has been located as a primary source of support, empirical research on the dynamics of close personal relationships in chronic illness experience remains a challenge.

OBJECTIVE

To explore the role of family relationships in supporting self-care and the nature of social support exchanged within an online self-management training course.

METHODS

Qualitative thematic and narrative analysis of online discussion boards. Postings for 218 participants, divided between 11 groups were included for a course section that focused on 'difficult emotions'.

RESULTS

Participants exchanged a high degree of emotional support and revealed much about their 'real life' relationships. The latter highlighted the complexities of managing illness within family contexts alongside additional pressures of daily life such as caring commitments and work roles.

DISCUSSION

The private interactive space created within the course allowed insights into the dynamics of family life associated with illness management that are challenging to research. Simultaneously, collective support was developed amongst this group of predominantly working women. The article points to the implications for such interventions and associated evaluative research beyond this selective group.

The characteristics and motivations of online health information seekers: cross-sectional survey and qualitative interview study

Background

Most households in the United Kingdom have Internet access, and health-related Internet use is increasing. The National Health Service (NHS) Direct website is the major UK provider of online health information.

Objective

Our objective was to identify the characteristics and motivations of online health information seekers accessing the NHS Direct website, and to examine the benefits and challenges of the health Internet.

Methods

We undertook an online questionnaire survey, offered to users of the NHS Direct website. A subsample of survey respondents participated in in-depth, semistructured, qualitative interviews by telephone or instant messaging/email. Questionnaire results were analyzed using chi-square statistics. Thematic coding with constant comparison was used for interview transcript analysis.

Results

In total 792 respondents completed some or all of the survey: 71.2% (534/750 with data available) were aged under 45 years, 67.4% (511/758) were female, and 37.7% (286/759) had university-level qualifications. They sought information for themselves (545/781, 69.8%), someone else (172/781, 22.0%), or both (64/781, 8.2%). Women were more likely than men to seek help for someone else or both themselves and someone else (168/509 vs 61/242, χ²₂ = 6.35, P = .04). Prior consultation with a health professional was reported by 44.9% (346/770), although this was less common in younger age groups (<36 years) (χ²₁ = 24.22, P < .001). Participants aged 16 to 75 years (n = 26, 20 female, 6 male) were recruited for interview by telephone (n = 23) and instant messaging/email (n = 3). Four major interview themes were identified: motivations for seeking help online; benefits of seeking help in this way and some of the challenges faced; strategies employed in navigating online health information provision and determining what information to use and to trust; and specific comments regarding the NHS Direct website service. Within the motivation category, four concepts emerged: the desire for reassurance; the desire for a second opinion to challenge other information; the desire for greater understanding to supplement other information; and perceived external barriers to accessing information through traditional sources. The benefits clustered around three theme areas: convenience, coverage, and anonymity. Various challenges were discussed but no prominent theme emerged. Navigating online health information and determining what to trust was regarded as a “common sense” activity, and brand recognition was important. Specific comments about NHS Direct included the perception that the online service was integrated with traditional service provision.

Conclusions

This study supports a model of evolutionary rather than revolutionary change in online health information use. Given increasing resource constraints, the health care community needs to seek ways of promoting efficient and appropriate health service use, and should aim to harness the potential benefits of the Internet, informed by an understanding of how and why people go online for health.

Young men's health promotion and new information communication technologies: illuminating the issues and research agendas

The article examines the use of newer, interactive information and communication technologies (ICTs) in young men's health promotion (HP), drawing on gender theory, HP research and evidence on young men's Internet usage. The focus is on highlighting an agenda for research in terms of emerging issues. New forms of social media ICT (for example 'web 2'-based on-line social networking sites, micro-blogging services, i-phones and podcasts) have the potential to enable young men to engage with health information in new and interesting ways. Given concerns about young men's engagement with health services, innovative ICT formats, particularly using the Internet, have been tried. However, issues persist around surfing 'addiction', quality control and equal access. Approaches to HP using new ICTs offer distributed control over information content and quality and a lay social context for accessing information. Online communities can potentially legitimize young men's participation in discourses around health, and support sustained engagement. The article discusses how this could support young men to re-conceptualize healthy choices in the context of masculine imperatives and responsible citizenship if specific conditions are met (for trusting engagement) and risks addressed (such as commercial disinformation). The skill requirements for young men to engage effectively with new ICTs are explored, focusing on health literacy (HL). It is predicted that social marketing approaches to HP for young men will increasingly include new ICTs, making specific requirements for HL. These approaches may appeal narrowly to hegemonic masculinities or broadly to multiple masculinities, including those historically marginalized. Recommendations are made for future research.