Online health information seeking: the influence of age, information trustworthiness, and search challenges

Awareness of environmental carcinogens and cancer risk among Jordanians

BACKGROUND

In light of the existing body of scientific data, many substances are now recognized or reasonably assumed to be human carcinogens. Public knowledge about modifiable environmental carcinogens is regarded as a crucial first step in primary prevention. This study aimed to assess Jordanians' awareness of some of the recognized environmental human carcinogens and general cancer information.

METHODS

This study was conducted using a cross-sectional descriptive survey based on a questionnaire completed by Jordanian participants aged 18 or above. The questions consisted of the following sections: socio-demographic characteristics, questions about the prevalent and non-prevalent cancer types in Jordan and general causes of cancer, closed-ended questions to evaluate knowledge about environmental carcinogens as well as factors that influence the development of cancer, source of knowledge about carcinogens and interest in learning about human carcinogens, and the best way for prevention of cancer.

RESULTS

A total of 579 questionnaires were completed. Among respondents, 55.6% (n = 322) had a knowledge score ≥ 8 indicating good knowledge. However, low awareness was demonstrated regarding cancer-causing substances such as wood dust, Nitrosamines, Aflatoxins, Formaldehyde, Naphthalene, Asbestos, Benzene, and Arsenic. A significant portion of the participants failed to categorize infectious pathogens linked to cancer as variables that either cause cancer or raise the risk of developing cancer.

CONCLUSION

This study demonstrated a good level of awareness regarding some environmental carcinogens but also highlighted the lack of knowledge about other environmental carcinogens. These findings may provide a guide for future awareness programs by health authorities.

Health literacy and the use of digital tools in older patients with cancer and their younger counterparts: A multicenter, nationwide study

OBJECTIVES

To evaluate health literacy (HL), assess the use of digital tools/sources, and identify factors associated with low or moderate HL in older (aged ≥65) and younger (18-64) patients with cancer.

METHODS

A cross-sectional multicenter study including patients with cancer was conducted in 26 centers in France. HL was assessed using the Functional, Communicative and Critical Health Literacy (FCCHL) scale. Factors associated with low/moderate HL (score

RESULTS

The population comprised 669 patients aged 18-64 and 658 patients aged 65 + . The older patients used digital tools less than younger patients did. The median overall HL score was: 3.7 and 3.6, for younger and older patients respectively. The need for help to fill out the questionnaire was associated with low/moderate HL in both age groups. Then, older age and living in rural area were associated with low/moderate HL in younger patients only, and rare internet use in older patients.

CONCLUSION

This article highlights the importance of considering HL in care management, as well as whom patients may present higher risk of low HL.

PRACTICE IMPLICATIONS

It is crucial to assess HL in patients with cancer, and then to seize every opportunity to enhance HL.

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Key Words

• Cancer
• Digital tools
• Internet use
• Literacy
• Older adults

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Affiliation(s)

Elena Paillaud Université Paris Cité, Department of Geriatrics, European Georges Pompidou Hospital, Paris Cancer Institute CARPEM, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75015 Paris, France; Paris Est Créteil University, INSERM, IMRB, F-94010 Creteil, France
Angéline Galvin Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR, 1219, Bordeaux, France.
Solène Doublet Université Paris Cité, Department of Geriatrics, European Georges Pompidou Hospital, Paris Cancer Institute CARPEM, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75015 Paris, France
Johanne Poisson Université Paris Cité, Department of Geriatrics, European Georges Pompidou Hospital, Paris Cancer Institute CARPEM, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75015 Paris, France
Pierre Gay Université Paris Cité, Department of Geriatrics, European Georges Pompidou Hospital, Paris Cancer Institute CARPEM, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75015 Paris, France
Christophe Perrin Centre Eugène Marquis, Comprehensive Cancer Center, Rennes, France
Pascaline Boudou-Rouquette Department of Medical Oncology, Hôpital Cochin Port-Royal, ARIANE, Paris Cancer Institute CARPEM, Assistance-Publique Hôpitaux de Paris (AP-HP), Paris, France
Thomas Grellety Centre Hospitalier de la Côte Basque, Bayonne, France
Diego Teyssonneau Institut Bergonie, Comprehensive Cancer Center, Bordeaux, France
Siavoshe Ayati Centre Georges-François Leclerc, Comprehensive Cancer Center, Dijon, France
Arnaud Saint-Lezer Centre hospitalier de Mont-de-Marsan, Mont-De-Marsan, France
Stéphane Culine Université Paris-Cité, Department of Medical Oncology, Hospital Saint-Louis, AP-HP Nord, Paris, France
Mylène Annonay Centre hospitalier de Martinique, Fort-De-France, France
Heidi Solem-Laviec Centre Francois Baclesse, Comprehensive Cancer Center, Caen, France
Rabia Boulahssass Geriatric Coordination Unit for Geriatric Oncology (UCOG), Centre Hospitalier Universitaire de Nice, Nice, France; FHU OncoAge, Nice, France; University Côte d'Azur, Nice, France
Capucine Baldini Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
Achille Tchalla Centre hospitalier universitaire de Limoges, Geriatric medicine unit, Limoges, France
Caroline Lalet Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Center, Bordeaux, France
Lucas Hue Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Center, Bordeaux, France
Marina Pulido Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Center, Bordeaux, France
Simone Mathoulin-Pélissier Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR, 1219, Bordeaux, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Center, Bordeaux, France

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Digital Media Usage Behavior and Its Impact on the Physician-Patient Relationship: Cross-Sectional Study Among Individuals Affected by Psoriasis in Germany

BACKGROUND

Psoriasis is a chronic skin disorder with a high burden of disease. People affected with psoriasis increasingly use the internet for health-related reasons, especially those with younger age, higher education, and higher disease severity. Despite advantages such as enhancing the individuals' knowledge with the use of digital media for health-related issues, disadvantages were also present such as quality control, and variability in the individuals' health information literacy. While patients with psoriasis within medical settings generally trust physicians over digital media, they commonly withhold their web-based research findings from health care providers.

OBJECTIVE

The study aims to (1) identify further factors associated with regular psoriasis-related internet use, (2) rank specific digital media platforms used, and (3) examine digital media within the physician-patient relationship among individuals with and without dermatological treatment.

METHODS

A cross-sectional, questionnaire-based study was conducted among individuals with self-reported psoriasis in Germany between September 2021 and February 2022. Participants were recruited via digital media platforms and in person at a University Hospital Department of Dermatology in southern Germany. The questionnaire asked about demographic and medical information, individual psoriasis-related digital media use, and the impact of digital media on the physician-patient relationship. Data were analyzed descriptively, and logistic regression models were performed to assess the factors associated with regular psoriasis-related internet use.

RESULTS

Among 321 individuals with a median age of 53 (IQR 41-61) years (nonnormally distributed; females: 195/321), female sex, shorter disease duration, moderate mental burden of disease, and good self-assessed psoriasis-related knowledge were associated with regular psoriasis-related internet use. Of the 188 participants with a mean age of 51.2 (SD 13.9) years (normally distributed) who used digital media 106 (56.4%) usually searched for information on psoriasis-based websites and 98 (52.1%) on search engines, primarily for obtaining information about the disease and therapy options, while social media were less frequently used (49/188, 26.1%). Nearly two-thirds of internet users (125/188) claimed that their physicians did not recommend digital media platforms. About 44% (82/188) of the individuals reported to seek for additional information due to the insufficient information provided by their physician.

CONCLUSIONS

This study revealed the importance of digital media in the context of psoriasis, especially among women, individuals with shorter disease duration, and moderate mental disease severity. The lack of physicians' digital media recommendations despite their patients' desire to receive such and being more involved in health-related decisions seems to be a shortcoming within the physician-patient relationships. Physicians should guide their patients on digital media by recommending platforms with evidence-based information, thereby potentially creating an adequate framework for shared decision-making. Future research should focus on strategies to prevent the spread of false information on digital media and address the needs of patients and physicians to enhance health-related digital media offerings.

Health Communication in an Era of Disinformation: Perceived Source Credibility Among Transgender and Gender Diverse Individuals

This study examines perceived source credibility of health information in a moment of TGD health disinformation. Through thematic analysis of in-depth interviews with 30 transgender and gender diverse (TGD) individuals, findings suggest health information is marred by anti-TGD legislation, a sociopolitical force that bleeds into health information spaces. Disinformation and TGD health communication are intertwined in complex ways, whereby disinformation can undermine trust in healthcare institutions, lead to harmful behaviors, and contribute to the spread of diseases. Health communication practitioners need to center the safety and humanity of TGD people, addressing TGD health disinformation.

US black women's pregnancy communication networks: A qualitative network analysis

The ongoing Black maternal health crisis necessitates a closer examination of how Black women in the United States utilize communication to mitigate the dangers racism poses for pregnancy, delivery and the postpartum period. Previous studies have highlighted the importance of supportive networks to Black women's wellbeing during pregnancy. However, few studies utilize a qualitative network approach to explore communication about pregnancy and related risks within a social network. Twenty-eight Black women from 12 US states who self-identified as previously, currently or recently pregnant, were recruited to participate in this study. Following data collection, participants' networks and related commentary from the interview were qualitatively analyzed for composition and context of networks (who is in the network and why?) and the content of communication (what is discussed and how?). This study found that Black women's perceptions of pregnancy risk and enactment of agency in response to risk was influenced by communication with individuals within their communication networks. The findings of this study also demonstrate that emotional support and guidance for navigating the dangers of the healthcare system constituted an important component of communication with strong ties, including partners, family members and close friends. Additionally, Black women enacted agency in response to pregnancy risk by leaning on trusted experts (healthcare providers) within their networks. However, this study also found limitations to the role of pregnancy communication networks. First, negative ties (relations) with alters (individuals with whom Black women have communication ties) and unwanted advice or guidance was found to be a source of stress. Furthermore, although mothers were an essential source of support for many women, differences related to generation, culture and the circumstances of pregnancy limited the relevance of the advice Black women receive from their mothers. Finally, immigrant women faced an additional challenge, as their support networks were sometimes geographically distant from them.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Trust in Mass Media as Sources of Cancer Information: Findings from a Nationally Representative Cross-Sectional Survey in Japan

Trust is a major factor in effective public dissemination and use of relevant health information to guide important health decisions. To examine mass media as a communication channel for delivering cancer information among Japanese adults, we identified the level of trust in various types of mass media as sources of cancer information, and examined factors associated with trust, including exposure to mass media, sociodemographic factors, and cancer history. Data were analyzed for 3,109 Japanese adults who responded to a nationally representative cross-sectional mail survey. Data included trust in cancer information sources, sociodemographic variables, cancer history, and exposure to mass media. Logistic regression analysis was used. The prevalence of high trust in cancer information sources was highest for physicians (94.7%). Among mass media, Internet (47.2%) was the most trusted source of cancer-related information, followed by television (44.3%), newspapers/magazines (42.7%), and radio (32.7%). The high-exposure group for newspapers (AOR = 1.28, 95%CI = 1.07-1.54) was more likely to trust newspapers. Similarly, high-exposure groups for radio (1.22, 1.02-1.45), Internet (1.21, 1.01-1.45), and television (1.30, 1.10-1.53) were positively associated with trust in each media type. Although trust in mass media was lower than trust in physicians, the study found that a large group of respondents had high levels of trust in mass media sources. Trust in cancer information from each mass media type was mainly related to the level of exposure to each mass media type. Developing health communication strategies using mass media may be effective for disseminating relevant cancer information in Japan.

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

Objective

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

Methods

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

Results

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

Conclusions

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

Changed Digital Technology Perceptions and Influencing Factors among Older Adults during the COVID-19 Pandemic

This correlational study aimed to identify factors that contribute to changes in perceptions of digital technology among older adults during the COVID-19 pandemic. This study utilized raw data from "The 2021 Report on the Digital Divide," a nationwide survey conducted in South Korea. Data were collected from 1171 older adults (aged ≥ 65 years) from September to December 2021. Multiple regression analyses were performed to examine the factors influencing changes in the perception of digital technology. Over one-third of the participants reported positive changes in their perceptions of digital technology during the pandemic. Key factors included self-efficacy for digital devices (β = 0.35, p < 0.001), digital networking (β = 0.11, p < 0.001), accessibility to digital devices (β = 0.10, p = 0.002), and perceived health (β = 0.08, p = 0.003). The expansion of digital technology owing to the pandemic has served as a catalyst for changes in older adults' perceptions. Healthcare providers and caregivers should consider digital technology perceptions and influencing factors when providing digital healthcare services. The results can be utilized to identify vulnerable older adults with negative perceptions of digital technology, thus minimizing disparities in access to digital healthcare services.

Understanding Information Processing and Protective Behaviors during the Pandemic: A Three-Wave Longitudinal Study

BACKGROUND

Few existing studies have examined information processing as an independent variable to predict subsequent information behaviors in a pandemic context, and the mechanism of subsequent information behavior processing following the initial or prior information behavior is unclear.

OBJECTIVE

Our study aims to apply the risk information seeking and processing model to explain the mechanism of subsequent systematic information processing in the context of the COVID-19 pandemic.

METHODS

A three-wave longitudinal online national survey was administered during the period of July 2020 to September 2020. Path analysis was conducted to test the relationships between prior and subsequent systematic information processing and protective behaviors.

RESULTS

One important finding was the key role of prior systematic information processing, as indirect hazard experience was found to be a direct predictor of risk perception (β = 0.15, p = 0.004) and an indirect predictor of protective behaviors. Another important finding was the central role of information insufficiency as a mediator/driving force in subsequent systematic information processing and protective behavior.

CONCLUSIONS

The study has made important contributions in that it extends the scholarship on health information behaviors by (a) highlighting that relevant hazard experience in risk information seeking and processing model should be expanded to include indirect experience, and (b) providing the mechanism of subsequent systematic information processing following prior information processing. Our study also provides practical implications on health/risk communication and protective behaviors' promotion in the pandemic context.

Online Search Patterns about Vaccination: A National Study

Introduction

Google Trends is an online metadata platform that measures the relative search volume of every topic in online search engines. In medical settings, this behavior has been associated with active changes in people's perceptions and search for healthcare. This study aimed to evaluate the online search patterns of Portuguese extra-program and risk-based vaccination.

Methods

Analysis of the relative search volume was performed for extra-program and risk-based vaccines, in every Portuguese district between 2006 and 2021. Relative search volume was represented between 0 and 100 (highest interest in the query).

Results

Rotavirus vaccine was consistently the most searched, followed by BCG and flu, the last of which, with abnormal peaks of search in November 2009 and October 2020. We registered a significant increase in the search for every vaccine in the last 5 years (p < 0.01). Particularly, during the COVID-19 pandemic, a more abrupt increase was registered for the flu vaccine, but most importantly for BCG (3,0[69,9] vs. 9,0[528,0]). Lisboa and Porto are the only Portuguese districts where percentual research is spread across all types of vaccines. On the other hand, in Portalegre, 84% of total searches correspond to BCG.

Discussion and Conclusion

The recent increase in the interest in vaccination may translate into the investment of health professionals in primary prevention measures. However, the mediatic impact of pandemics is not neglectable. Health professionals must fight misinformation as it may have happened with the increasing interest in BCG, probably due to the protective association proposed with the infection by SARS-CoV-2.

Quality analysis of YouTube videos on vulvodynia

Background

Social media, with its low cost and easy accessibility, represents an ideal medium for sharing medical interests, but the quality of its content is questionable.

Aim

The primary aim of this study was to evaluate the quality of video content related to vaginismus on YouTube as a source of information by using scores of established classification systems. The secondary aim was to examine the relationship between objective and subjective measures of their quality.

Methods

The term vaginismus was typed into the YouTube search bar (http://www.youtube.com). The first 50 videos with the highest number of views were included in the study. All videos were assessed on August 18, 2022, by a gynecologist and/or a urologist experienced in vulvodynia. Data of all the videos were recorded, such as source, content, duration, day since upload date, number of views, number of likes, number of comments, and views per day. The Global Quality Scale (GQS) and modified DISCERN score were employed to assess the quality of the videos.

Outcomes

The primary outcomes of this study were the scores of established classification systems and the measures relating to the preference and evaluation of viewers of YouTube videos on vulvodynia.

Results

A total of 50 videos were evaluated. The sources of 32 (64%) of these videos were “universities/professional organizations/nonprofit physicians/physicians” and “stand-alone health information websites.” The GQS and modified DISCERN scores of the videos whose source was “universities/professional organizations/nonprofit physicians/physicians” were higher than those whose source was “talk show programs/television programs” (P = .014 for GQS score, P = .046 for modified DISCERN score). When classified according to GQS score, the quality level of 58% of the videos was low. Of the videos whose source was “universities/professional organizations/nonprofit physicians/physicians,” 56.3% were of good quality.

Clinical Implications

The quality of information was very low and suggested that health care professionals should take on a more active role in configuring the qualitative characteristics of the material available online about the given health issues.

Strengths and Limitations

To the best of our knowledge, this is the first study to investigate the quality of YouTube videos on vaginismus (vulvodynia). However, the limitation of this study is the relatively subjective evaluation of videos, including the risk of observer bias, although we attempted to overcome this problem with the inclusion of 2 independent reviewers and the use of validated tools.

Conclusion

YouTube videos may offer a huge amount of information about this condition, but the quality of the available sources is heterogeneous.

Positive Emotion and Media Dependence: Measuring Risk Information Seeking and Perception in the COVID-19 Pandemic Prevention

Risk perception and information seeking behaviors are affected by individual psychological and situational factors. In the background of COVID-19 prevailing for a long period, this study examined Chinese people's information seeking and processing behavior by the RISP model, which focused on the impact of individual risk perception, affective response, perceived information-gathering capacity, and media trust and the impact of the above factors on information seeking. This study designed an online survey with gender and age quotas among the Chinese population, including a total of 675 valid samples. It was found that the Chinese public's risk perception to pandemic had a positive effect on perceived information-gathering capacity and media trust. Furthermore, both positive emotional responses and negative emotional responses had a positive effect on information seeking behavior. Nurturing positive emotion engendered a holistic perception in pandemic information seeking. In addition, media trust, perceived information-gathering capacity, and subjective norms also positively impact information seeking behavior.

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

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

Health Disparities in Online COVID-19 Information Seeking and Protective Behaviors: A Two-Wave Longitudinal Study

The COVID-19 outbreak was declared a pandemic by the World Health Organization and claimed hundreds of thousands of lives in the U.S. However, the adoption of protective behaviors in response to COVID-19 varies among sociodemographic groups. To better understand the disparities in U.S. adults' adoption of protective behaviors in relation to sociodemographic factors, we conducted a two-wave panel survey in the U.S. Although sociodemographic factors were not found to be significant predictors in lagged regression analysis, results from a cross-sectional analysis showed that the White, younger, and higher educated individuals were more likely to take protective behaviors. Furthermore, based on the structural equation modeling, indirect effects were observed. Specifically, online COVID-19 information seeking mediated the effects of age and education on performance of protective behaviors, and subjective norms and online COVID-19 information seeking were found to be significant serial mediators of these relationships. The study not only extends the health disparities and health information seeking literature, but also offers practical insights to health campaigns and interventions promoting protective behaviors during a pandemic and reducing health disparities.

How users make judgements about the quality of online health information: a cross-sectional survey study

BACKGROUND

People increasingly use the Internet to seek health information. However, the overall quality of online health information remains low. This situation is exacerbated by the unprecedented "infodemic", which has had negative consequences for patients. Therefore, it is important to understand how users make judgements about health information by applying different judgement criteria.

OBJECTIVE

The objective of this study is to determine how patients apply different criteria in their judgement of the quality of online health information during the pandemic. In particular, we investigate whether there is consistency between the likelihood of using a particular judgement criterion and its perceived importance among different groups of users.

METHODS

A cross-sectional survey was conducted in one of the leading hospitals in a coastal province of China with a population of forty million. Combined-strategy sampling was used to balance the randomness and the practicality of the recruiting process. A total of 1063 patients were recruited for this study. Chi-square and Kruskal-Wallis analyses were used to analyse the survey data.

RESULTS

In general, patients make quality judgement of health information more frequently based on whether it is familiar, aesthetic, and with expertise. In comparison, they put more weights on whether health information is secure, trustworthy, and with expertise when determining its quality. Criteria that were considered more important were not always those with a higher likelihood of being used. Patients may not use particular criteria, such as familiarity, identification, and readability, more frequently than others even if they consider them to be more important than other do and vice versa. Surprisingly, patients with a primary school degree put more weight on whether health information is comprehensive than those with higher degrees do in determining its quality. However, they are less likely to use this guideline in practice.

CONCLUSIONS

To the best of our knowledge, this is the first study to investigate the consistency between the likelihood of using certain quality judgement criteria and their perceived importance among patients grouped by different demographic variables and eHealth literacy levels. The findings highlight how to improve online health information services and provide fine-grained customization of information for users.

Health Information Sourcing and Health Knowledge Quality: Repeated Cross-sectional Survey

Background

People’s health-related knowledge influences health outcomes, as this knowledge may influence whether individuals follow advice from their doctors or public health agencies. Yet, little attention has been paid to where people obtain health information and how these information sources relate to the quality of knowledge.

Objective

We aim to discover what information sources people use to learn about health conditions, how these sources relate to the quality of their health knowledge, and how both the number of information sources and health knowledge change over time.

Methods

We surveyed 200 different individuals at 12 time points from March through September 2020. At each time point, we elicited participants’ knowledge about causes, risk factors, and preventative interventions for 8 viral (Ebola, common cold, COVID-19, Zika) and nonviral (food allergies, amyotrophic lateral sclerosis [ALS], strep throat, stroke) illnesses. Participants were further asked how they learned about each illness and to rate how much they trust various sources of health information.

Results

We found that participants used different information sources to obtain health information about common illnesses (food allergies, strep throat, stroke) compared to emerging illnesses (Ebola, common cold, COVID-19, Zika). Participants relied mainly on news media, government agencies, and social media for information about emerging illnesses, while learning about common illnesses from family, friends, and medical professionals. Participants relied on social media for information about COVID-19, with their knowledge accuracy of COVID-19 declining over the course of the pandemic. The number of information sources participants used was positively correlated with health knowledge quality, though there was no relationship with the specific source types consulted.

Conclusions

Building on prior work on health information seeking and factors affecting health knowledge, we now find that people systematically consult different types of information sources by illness type and that the number of information sources people use affects the quality of individuals’ health knowledge. Interventions to disseminate health information may need to be targeted to where individuals are likely to seek out information, and these information sources differ systematically by illness type.

The complementary and substitutive value of online health information

The Internet plays a significant role in health information searching, sharing and emotional support. However, scholars have devoted little attention to the complementary and substitute value of online health information from diseases, especially chronic diseases, health insurance, barriers to health resources and their interaction effects with income. This research uses data from the 2020 Health Information National Trends Survey (HINTS 2020), the latest HINTS survey that includes seeking online health information questions critical to this research. This paper proposes that the factors contributing to seeking online health information can be categorized into two modalities - complementary and substitutive. Concerning the complementary value, I argue that individuals with certain health conditions use online health information as a complementary health resource in addition to traditional health resources such as doctors to understand their health issues better. Online health information also functions as substitute information sources for individuals who have experienced more barriers to typical health information resources.

Social capital and health information seeking in China

Background

People’s potentials to seek health information can be affected by their social context, such as their social networks and the resources provided through those social networks. In the past decades, the concept of social capital has been widely used in the health realm to indicate people’s social context. However, not many such studies were conducted in China. Chinese society has its special quality that many Western societies lack: people traditionally render strong value to family relations and rely heavily on strong social ties in their social life. Therefore, the purpose of this study was to examine the association between different types of social capital and health information-seeking behavior (HISB) in the Chinese context. The different types of social capital were primarily bonding and bridging, as well as cognitive and structural ones.

Methods

Our analysis is based on a total of 3090 cases taken from the Health Information National Trends Survey (HINTS) – China, 2017. Dataset was weighted due to the overrepresentation of female respondents and hierarchical multiple regression analyses as well as binary logistic regression tests were operated to examine the associations between people’s social capital and their HISB.

Results

Some aspects of social capital emerged as positive predictors of HISB: information support (standing in for the cognitive component of social capital) promoted health information seeking, organization memberships (standing in for the structural component) encouraged cancer information seeking, and both the use of the internet and of traditional media for gaining health information were positively linked with bridging networks and organization memberships. Bonding networks (structural component) were not correlated with any other of the key variables and emotional support (cognitive social capital) was consistently associated with all health information-seeking indicators negatively.

Conclusions

Social capital demonstrated significant and complex relationships with HISB in China. Structural social capital generally encouraged HISB in China, especially the bridging aspects including bridging networks and organization memberships. On the other hand, emotional support as cognitive social capital damaged people’s initiatives in seeking health-related information.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13895-2.

Disparity and Factors Associated With Internet Health Information Seeking Among US Adults Living With Diabetes Mellitus: Cross-sectional Study

Background

Many patients with chronic medical conditions search the internet to obtain medical advice and health information to improve their health condition and quality of life. Diabetes is a common chronic disease that disproportionately affects different race and ethnicity groups in the United States. In the existing literature on the popularity of internet health information seeking among persons with a chronic medical condition, there are limited data on US adults living with diabetes.

Objective

This study aims to examine the factors associated with internet health information seeking among US adults living with diabetes and whether there is a disparity in internet health information seeking stratified by race and ethnicity.

Methods

We conducted a cross-sectional study using the Health Information National Trends Survey data from 2017 to 2020. We selected our study sample based on respondents’ reports on whether they were told they had diabetes, and our primary outcome was internet health information–seeking behavior. We used 2 multivariable logistic regression models to examine the effects of sociodemographic factors and other covariates on the internet health information–seeking behavior of adults with diabetes. Jackknife replicate weights were used to provide bias-corrected variance estimates.

Results

Our study sample included 2903 adults who self-reported that they had diabetes. In total, 60.08% (1744/2903) were non-Hispanic White individuals, 46.88% (1336/2850) were men, and 64% (1812/2831) had some college or graduate education. The prevalence of internet health information seeking in this population was 64.49% (1872/2903), and the main factors associated with internet health information seeking included education level (some college vs less than high school: odds ratio [OR] 1.42, 95% CI 1.44-1.88; and college graduate or higher vs less than high school: OR 2.50, 95% CI 1.79-3.50), age (age group ≥65 years vs age group 18-44 years: OR 0.46, 95% CI 0.34-0.63), and household income level (P<.001). In addition, we found significant differences in the effects of predictors stratified by race.

Conclusions

The findings from this study suggest that internet health information seeking is common among US adults living with diabetes. Internet health information could influence the relationship between health care providers and adults living with diabetes and improve their self-management and quality of life.

An Empirical Study of Older Adult’s Voice Assistant Use for Health Information Seeking

Although voice assistants are increasingly being adopted by older adults, we lack empirical research on how they interact with these devices for health information seeking. Also, prior work shows how voice assistant responses can provide misleading or inaccurate information and be harmful particularly in health contexts. Because of increased health needs while aging, this paper studies older adult’s (ages 65+) health-related voice assistant interactions. Motivated by a lack of empirical evidence for how older adults approach information seeking with emerging technologies, we first conducted a survey of n = 201 older adults to understand how they engage voice assistants compared to a range of offline and digital sources for health information seeking. Findings show how voice assistants were used for confirmatory health queries, with users showing signs of distrust. As much prior work focuses on perceptions of voice assistant use, we conducted scenario-based interviews with n = 35 older adults to study health-related voice assistant behavior. In interviews, participants engaged with different health topics (flu, migraine, high blood pressure) and scenario types (symptom-driven, behavior-driven) using a voice assistant. Findings show how conversational and human-like expectations with voice assistants lead to information breakdowns between the older adult and voice assistant. This paper contributes a nuanced query-level analysis of older adults’ voice-based health information seeking behaviors. Further, data provide evidence for how query reformulation happens with complex topics in voice-based information seeking. We use our findings to discuss how voice interfaces can better support older adults’ health information seeking behaviors and expectations.

A Framework for Online Public Health Debates: Some Design Elements for Visual Analytics Systems

Nowadays, many people are deeply concerned about their physical well-being; as a result, they invest much time and effort investigating health-related topics. In response to this, many online websites and social media profiles have been created, resulting in a plethora of information on such topics. In a given topic, oftentimes, much of the information is conflicting, resulting in online camps that have different positions and arguments. We refer to the collection of all such positionings and entrenched camps on a topic such as an online public health debate. The information people encounter regarding such debates can ultimately influence how they make decisions, what they believe, and how they act. Therefore, there is a need for public health stakeholders (i.e., people with a vested interest in public health issues) to be able to make sense of online debates quickly and accurately. In this paper, we present a framework-based approach for investigating online public health debates—a preliminary work that can be expanded upon. We first introduce the concept of online debate entities (ODEs), which is a generalization for those who participate in online debates (e.g., websites and Twitter profiles). We then present the framework ODIN (Online Debate entIty aNalyzer), in which we identify, define, and justify ODE attributes that we consider important for making sense of online debates. Next, we provide an overview of four online public health debates (vaccines, statins, cannabis, and dieting plans) using ODIN. Finally, we showcase four prototype visual analytics systems whose design elements are informed by the ODIN framework.

Electronic health literacy and health-related outcomes among older adults: A systematic review

This review aims to identify, appraise, and synthesize research evidence of the association between electronic health (eHealth) literacy and health outcomes in older adults. English-written articles that presented the relationships between eHealth literacy and health-related outcomes in older adults were identified by searching five scientific databases (Web of Science, PubMed, Cochrane Library, APA PsycInfo, and EMBASE) hand-searching reference lists. Searches yielded 2993 studies after duplicates were removed, of which 24 publications were included in the final review. eHealth literacy was relatively low in older adults, and the eHealth Literacy Scale, developed by Norman and Skinner in 2006, was the most frequently used instrument in the included studies (21/24, 87.5%). The health-related outcomes associated with eHealth literacy were grouped into four categories: physical, behavioral, psychosocial, and cognitive. For behavioral (e.g., health-promoting behaviors, self-care, and medication adherence) and cognitive (e.g., health knowledge and health decision making) outcomes, the evidence was mostly consistent that eHealth literacy was positively associated with better outcomes. For physical (e.g., health-related quality of life) and psychosocial outcomes (e.g., anxiety and self-efficacy), the associations were less consistent, with some studies showing significant associations while others showed no associations. Most included studies were assessed as moderate quality. Overall, higher eHealth literacy is associated with more positive health behaviors and better health knowledge and attitude in older adults, however, the associations with some physical and psychosocial outcomes are less consistent. Clarifying the pathways of the relationships between eHealth literacy and some health-related outcomes is needed for further exploring their underlying mechanisms.

Correlates of Older Adults' E-Health Information-Seeking Behaviors

Introduction

The Internet is an important source for health information and a medium for older adults' empowerment in health decision-making and self-caring. Therefore, we aimed to identify the potential motivators and probable barriers of e-health information-seeking behaviors (e-HISB) among older Iranian adults.

Methods

A cross-sectional study assessed the usefulness of self-efficacy, perceived encouragement, positive attitude toward e-HISB, perceived usefulness, challenges of being visited by physicians, and perceived barriers in predicting e-HISB in a sample of 320 older adults in Tabriz, Iran.

Results

The self-efficacy for online information seeking, positive attitude toward e-HISB, and perceived usefulness increased the odds of e-HISB by 12.00%, 24.00%, and 15.00%, respectively. In addition, e-health literacy, conflicting information, distrust of online information, and web designs that were not senior-friendly were the major barriers to e-HISB.

Discussion/Conclusion

The theoretical and practical implications of the motivators and barriers of e-HISB can be instrumental in designing and executing programs aimed at improving e-health literacy among older adults especially during the COVID-19 pandemic.

The Digital Divide and Seeking Health Information on Smartphones in Asia: Survey Study of Ten Countries

Background

Although recent developments in mobile health have elevated the importance of how smartphones empower individuals to seek health information, research investigating this phenomenon in Asian countries has been rare.

Objective

The goal of our study was to provide a comprehensive profile of mobile health information seekers and to examine the individual- and country-level digital divide in Asia.

Methods

With survey data from 10 Asian countries (N=9086), we ran multilevel regression models to assess the effect of sociodemographic factors, technological factors, and country-level disparities on using smartphones to seek health information.

Results

Respondents who were women (β=.13, P<.001), parents (β=.16, P<.001), employed (β=.08, P=.002), of higher social status (β=.08, P<.001), and/or from countries with low health expenditures (β=.19, P=.02) were more likely to use smartphones to seek health information. In terms of technological factors, technology innovativeness (β=.10, P<.001) and frequency of smartphone use (β=.42, P<.001) were important factors of health information seeking, whereas the effect of online information quality was marginal (β=–.04, P<.001).

Conclusions

Among smartphone users in Asia, health information seeking varies according to individuals’ socioeconomic status, their innovativeness toward technology, and their frequency of smartphone use. Although smartphones widen the digital divide among individuals with different socioeconomic status, they also bridge the divide between countries with varying health expenditures. Smartphones appear to be a particularly useful complement to manage health in developing countries.

The Use of Multiple Imputation to Handle Missing Data in Secondary Datasets: Suggested Approaches when Missing Data Results from the Survey Structure

Secondary datasets are used in healthcare research because of its cost advantages, its convenience, and the size of the datasets. However, missing data can cause problems that are difficult to resolve. This manuscript reviews possible causes for missing data, and how to address them. Many researchers use multiple imputation as a solution, which consists of three phases: (a) the imputation phase, (b) the analysis phase, and (c) the pooling phase. When missing data is caused by a refusal to answer or by insufficient knowledge, multiple imputation works well. However, difficulties arise when there are problems with screening questions. If respondents do not answer a screening question, possible answers could be either “yes” or “no.” This paper suggests identifying “yes” responses on the screening question, and setting them aside for use in the analysis. The reasons for this approach are the impossibility of conducting multiple imputation twice, the problem of imputation based on the population after sample weight, and the difficulty of producing logical errors on the estimation in imputation phase. This manuscript uses as an example the techniques used to address missing data from screening questions in a national US dataset. These techniques of multiple imputation using examples from the dataset could be used by researchers in future healthcare research that relies on secondary datasets.

The Impact of Coronavirus Information-Seeking Behavior on Dental Care Access: A Cross-Sectional Questionnaire-Based Study

Health information-seeking behavior provides a variety of benefits, such as reducing knowledge gaps and educating individuals outside the medical office. This study aimed at evaluating if different sources used to gather information on COVID-19 could affect the willingness to undergo dental appointments. An anonymous survey was posted on social media. The 1003 respondents used several channels of communication, clearly distinguishing reliable from unreliable ones. Multiple logistic regression estimated the effect of different information channels on the probability of being strongly influenced by COVID-19 in accessing upcoming dental appointments. Newspapers were the most-used channel of information (61.2%), blogs and forums the least used (11.2%). Overall, the more an individual was informed, the higher was the risk of missing upcoming dental care appointments (OR 2.05, CI 1.45–2.90, p < 0.001). The two most reliable channels of communication were identified in journals/websites of medicine and healthcare professionals. Women proved to be more active in gathering information and relying on less secure but more personal channels, such as social media and friends and family, thus having an increased risk of being influenced by COVID-19 information regarding upcoming dental care appointments (OR 3.62, CI 0.85–15.52, p < 0.1 and OR 1.60, CI 1.00–2.58, p < 0.1, respectively). Social media should have a greater presence on the side of medical service providers to avoid distortions of information and fake news that ultimately cause fear among citizens and compromise their health. Healthcare professionals and institutions should adapt their communication channels based on the audience they want to address to optimize the education and information of the final users.

Analysis on Health Information Acquisition of Social Network Users by Opinion Mining: Case Analysis Based on the Discussion on COVID-19 Vaccinations

This study aims to explore phenomena and laws that occur when different users on social network platforms obtain health information by constructing an opinion mining model, analyzing the user's position on selected cases, and exploring the reflection of the phenomenon of truth decay on platforms. It selects group posts regarding the COVID-19 vaccination dispute on the Douban platform, analyzes the positions of different users, and explores phenomena related to users obtaining health information on domestic social platforms according to different topics and information behaviors. The results reveal a linear relationship between the negative and neutral attitudes of netizens on social networking platforms. Moreover, netizens tend to hold subjective language when expressing their views and attitudes, and their views on social platforms will not change easily. The study explores the health information acquisition behavior of netizens on social platforms based on the constructed user opinion mining model. The study is helpful for relevant units and platforms to make scientific decisions and provide guidance according to different positions of Internet users.

Online Health Information Seeking: A Review and Meta-Analysis

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

Characterizing the dissemination of misinformation on social media in health emergencies: An empirical study based on COVID-19

The dissemination of misinformation in health emergencies poses serious threats to public health and increases health anxiety. To understand the underlying mechanism of the dissemination of misinformation regarding health emergencies, this study creatively draws on social support theory and text mining. It also explores the roles of different types of misinformation, including health advice and caution misinformation and health help-seeking misinformation, and emotional support in affecting individuals' misinformation dissemination behavior on social media and whether such relationships are contingent on misinformation ambiguity and richness. The theoretical model is tested using 12,101 textual data about COVID-19 collected from Sina Weibo, a leading social media platform in China. The empirical results show that health caution and advice, help seeking misinformation, and emotional support significantly increase the dissemination of misinformation. Furthermore, when the level of ambiguity and richness regarding misinformation is high, the effect of health caution and advice misinformation is strengthened, whereas the effect of health help-seeking misinformation and emotional support is weakened, indicating both dark and bright misinformation ambiguity and richness. This study contributes to the literature on misinformation dissemination behavior on social media during health emergencies and social support theory and provides implications for practice.

Relationship between stressful life events, stigma and life satisfaction with the willingness of disclosure of psychotic illness: A community study in Hong Kong

AIM

The preference of and potential barriers to disclosure of psychotic illness vary across cultures. Studying its patterns and correlates can guide the design of future culture-specific intervention and public education approaches to improve willingness to disclose and thereby reducing the duration of untreated psychosis (DUP).

METHODS

A population-based, random telephone survey was conducted with a total of 1514 respondents in Hong Kong in January 2018. Cross-sectional data on willingness to disclose psychotic illness, life satisfaction, stigmatizing attitude and recent experience of stressful life events (SLEs) were analysed against age and gender using structural equation modelling (SEM).

RESULTS

Unwillingness to disclose to anyone was reported by 12% of the participants. Family was reported as the preferred disclosure candidate by most respondents. Our model, which showed a good fit to the data demonstrated that stigmatizing attitude and life satisfaction were directly associated with willingness to disclose illness. Younger age was correlated with more recent experience of SLEs, lower life satisfaction and less willingness to disclose illness. Women's disclosure willingness was positively associated with their life satisfaction, which was sensitive to recent exposure to single SLE. In contrast, men's was negatively associated with their stigmatizing attitude, which increased significantly upon exposure to two or more recent SLEs.

CONCLUSION

Encouraging the public to help their family to seek treatment should be a focal point of a successful mental health public education campaign. Cultural-specific and integrated interventions should be developed targeting the vulnerable groups including people with high recent life stress, particularly woman and those with younger age.

Generation Gaps in Digital Health Literacy and Their Impact on Health Information Seeking Behavior and Health Empowerment in Hungary

Background: Today the internet is a major source of health information, and younger generations have more confidence in their digital information seeking skills and awareness of online resources than older generations. Older generations, however, are more in demand of health services. The aim of our study was to explore these generational differences as related to self-perceived eHealth literacy and health care system utilization.

Methods: A cross-sectional survey study with 522 subjects was done in Hungary. Every subject belonged to one of four generations (Baby boomers, X, Y, and Z). The Web-based survey was designed and tested in English-speaking countries and translated into Hungarian for the present study. Variables include Internet health information seeking, eHealth literacy (measured by eHeals score), the self-perceived gain in empowerment by that information, and the number of health care appointments. One-way ANOVA was used for comparing the scores of the generations, and correlational and linear regression analysis was employed within the generations for further data analysis.

Results: We found significant differences among the generations in eHealth literacy as well as in the self-perceived gain in empowerment: while Boomers were the generation with the lowest eHeals scores, they showed the highest empowerment. Internet health information seeking behavior showed no differences. While subjects who use the Internet more frequently to search for health information have worse self-rated health status, the ones with higher eHeals scores report better subjective health status. We also identified the associations of the above variables within the older generations (Boomers and X) with the frequency of using health-care services: within the generation of Boomers the number of health care appointments was only associated with Internet health information seeking, while in Generation X with eHeals.

Conclusions: Baby boomers seek Internet health information as often as the younger generations, which provides a solid motivation for developing their eHealth literacy skills. We find it crucial to plan the Hungarian health promotion programmes utilizing this high frequency of Internet health information seeking, since the eHealth literacy skills of older generations have an effect on their subjective health status, and they are the most capable of applying information in making decisions.

Factors Associated With Perceived Trust of False Abortion Websites: Cross-sectional Online Survey

Background

Most patients use the internet to search for health information. While there is a vast repository of searchable information online, much of the content is unregulated and therefore potentially incorrect, conflicting, or confusing. Abortion information online is particularly prone to being inaccurate as antichoice websites publish purposefully misleading information in formats that appear as neutral resources. To understand how antichoice websites appear neutral, we need to understand the specific website features of antichoice websites that impart an impression of trustworthiness.

Objective

We sought to identify the characteristics of false or misleading abortion websites that make these websites appear trustworthy to the public.

Methods

We conducted a cross-sectional study using Amazon’s Mechanical Turk platform. We used validated questionnaires to ask participants to rate 11 antichoice websites and one neutral website identified by experts, focusing on website content, creators, and design. We collected sociodemographic data and participant views on abortion. We used a composite measure of “mean overall trust” as our primary outcome. Using correlation matrices, we determined which website characteristics were most associated with mean overall trust. Finally, we used linear regression to identify participant characteristics associated with overall trust.

Results

Our analytic sample included 498 participants aged from 22 to 70 years, and 50.1% (247/493) identified as female. Across 11 antichoice websites, creator confidence (“I believe that the creators of this website are honest and trustworthy”) had the highest correlation coefficient (strongest relationship) with mean overall trust (coefficient=0.70). Professional appearance (coefficient=0.59), look and feel (coefficient=0.59), perception that the information is created by experts (coefficient=0.59), association with a trustworthy organization (coefficient=0.58), valued features and functionalities (coefficient=0.54), and interactive capabilities (coefficient=0.52) all demonstrated strong relationships with mean overall trust. At the individual level, prochoice leaning was associated with higher overall trust of the neutral website (B=−0.43, 95% CI −0.87 to 0.01) and lower mean overall trust of the antichoice websites (B=0.52, 95% CI 0.05 to 0.99).

Conclusions

The mean overall trust of antichoice websites is most associated with design characteristics and perceived trustworthiness of website creators. Those who believe that access to abortion should be limited are more likely to have higher mean overall trust for antichoice websites.

Evolution of Online Health-Related Information Seeking in France From 2010 to 2017: Results From Nationally Representative Surveys

BACKGROUND

Given the rapid ongoing progression of the internet and increase in health information available from disparate online sources, it is important to understand how these changes impact online health information-seeking behavior of the population and the way of managing one's health.

OBJECTIVE

This paper aims at describing the evolution of internet use as a source of health information between 2010 and 2017, as well as the characteristics of online health information seekers, topics of interest, sources of information, and trust in retrieved information and potential impact on behavior.

METHODS

Data from the French nationally representative surveys Health Barometers were used (N=4141 in 2010, 4811 in 2014, and 6255 in 2017). Evolutions over time were assessed using chi-square tests. Associations with sociodemographic characteristics and health status were evaluated using logistic regression models.

RESULTS

The use of the internet as a source of health information rose between 2010 and 2014 (from 37.3% to 67.9%, P<.001) but decreased significantly in 2017 (60.3%, P<.001). Overall, the profile of health information seekers compared with nonseekers did not change over time. They were more likely to be women, to be younger, to have a higher educational level, to have a higher household income, and to be executives. Between 2014 and 2017, the proportion of those who did not pay attention to the source of information significantly increased to reach 39.7% (P<.001). In 2017 as in 2014, general health-related websites remained the first source of information (38.6%) while institutional websites were the third source (8.1%). Most information seekers trusted the information found online in 2010 (more than 80%), with a slight decrease between 2014 and 2017 (P=.048). Among individual characteristics, trust in the information was the main determinant of the way of managing one's health (odds ratio 4.06, 95% CI 3.26-5.06).

CONCLUSIONS

After a rapid growth in the internet use for seeking health information in the 2010 to 2014 period, a decrease was recorded in 2017, in parallel with a decrease in trust in the quality and reliability of information found online. These findings underline the need for public health authorities to increase citizens' eHealth literacy and to provide alternative trustworthy sources combining the popularity and accessibility of general health information websites.

Persistent digital divide in health-related internet use among cancer survivors: findings from the Health Information National Trends Survey, 2003-2018

PURPOSE

Prior research on the use of the internet among cancer survivors indicates a digital divide. The online landscape and patterns of information consumption, however, have notably changed over the past decade necessitating an updated examination of health-related internet use (HRIU) among cancer survivors.

METHODS

Using survey data from 2003, 2005, 2007, 2011, 2013, 2017, and 2018 Health Information National Trends Survey (HINTS) iterations, the objectives of this study were to report prevalence, trends, and user profiles in HRIU in terms of emailing doctors, buying medicine online, and support group participation. Descriptive analyses and weighted multivariate logistic regression analyses were performed.

RESULTS

Cancer survivors who reported not using the internet were more likely to be older, belong to ethnic minorities, be less educated, and reside in rural areas as compared with those who reported using the internet. Except for participation in online support groups, all other types of HRIU increased in prevalence across the years.

CONCLUSIONS

Consistent with the increased penetration of the internet and the altered online health communication landscape, we found increased prevalence of HRIU among cancer survivors. However, the digital divide persists in terms of internet access. These findings can inform initiatives to bridge the gap among survivors of varying profiles in using the internet for their health needs.

IMPLICATIONS FOR CANCER SURVIVORS

There is increased reliance on online platforms to obtain and communicate health-related information. The risk with this approach is potential oversight of ensuring equity in terms of internet access and technology literacy among survivors.

Perceived Needs Versus Predisposing/Enabling Characteristics in Relation to Internet Cancer Information Seeking Among the US and Chinese Public: Comparative Survey Research

Background

Since the rise of the internet, online health information seeking has become a worldwide phenomenon. However, health and health communication are inherently culture bound. A data-driven cross-country comparison enables us to better understand how cultural factors moderate the association between individual-level determinants and online health information seeking.

Objective

The objective of the study was to examine similarities and differences in determinants of internet cancer information seeking between the US and Chinese general public (excluding cancer patients and survivors) under the framework of a behavioral model of health services use.

Methods

This study used Health Information National Trends Survey (HINTS) 2017 (US data) and HINTS-China 2017 data to answer the research question. It focused on people with no cancer history and with internet access. For the HINTS 2017, the sample size was 2153; for the HINTS-China 2017, the sample size was 2358. To compare China and the United States, the researchers selected the same set of study variables for each dataset. Under the framework of the behavioral model of health services use, these predictors were predisposing factors, enabling factors, and need factors.

Results

In terms of the predisposing factors, a higher age, college degree or above, being currently unemployed, and having a family history of cancer were associated with internet cancer information seeking for the Chinese respondents; none of these factors were related to information seeking for the US respondents, although a lower age was associated with information seeking. Regarding the enabling conditions, lower trust in family members and friends as reliable information sources was the only factor associated with information seeking for the Chinese respondents, while no enabling factor was related to information seeking for the US respondents. Regarding the need factors, perceived health status was not related to information seeking for the Chinese respondents, while perception of poorer health condition was related to information seeking for the US respondents. Higher cancer fear was related to information seeking for both groups, but the magnitude of association was smaller for the Chinese respondents than for the US respondents.

Conclusions

Overall, under the framework of the behavioral model of health services use, the results based on multivariate logistic regression reveal clear patterns of cross-country/cultural differences in the factors associated with internet cancer information seeking behaviors: predisposing characteristics and enabling conditions are more important in China, while perceived needs are more significant in the US. Such differences might reflect possible US-China differences in job environment (eg, job pressure) and culture (individualism vs collectivism and family structure).

Can the adoption of health information on social media be predicted by information characteristics?

Purpose

This paper aims to explore the relationship between the characteristics of social media health information and its adoption. The purpose is to identify information characteristics that can be used to estimate the level of health information adoption in advance.

Design/methodology/approach

According to the Information Adoption Model (IAM), the study extracted ten information characteristics from the aspects of information quality and information source credibility. The sample data was collected from the top ten influential health accounts based on the Impact List of Sina Weibo to test the effectiveness of these characteristics in distinguishing information at different levels of adoption. The forecasting of information adoption level is regarded as a binary classification question in the study and support vector machine (SVM) is used to do the research.

Findings

The results indicate that ten information characteristics chosen in this study are related to information adoption. Based on these information characteristics, it is feasible to estimate the level of health information adoption, and the estimation accuracy is relatively high.

Originality/value

A lot of work has been done in previous researches to reveal the factors that influence information adoption. The theoretical contribution of this work is to further discuss how to use the influencing factors to do some predictive work for information adoption. In practice, it will help health information publishers to disseminate high-quality health information more effectively as well as promote the adoption of health information.

Developing and Testing the Populi Needle Exchange Point Finder: An App to Reduce Harm Associated With Intravenous Drug Consumption Among Homeless and Non-homeless Drug Users

The spread of viral infections remains a serious public health problem. People who inject drugs represent one of the highest-risk groups. eHealth and mHealth have been shown to be effective in improving individuals' management of their own health and their access to health care and to contribute to reducing the costs associated with certain medical interventions. People who inject drugs, including homeless people, tend to have access to technology. Young homeless people in particular are likely to use smartphones and social networking sites in ways that are similar to the general population. Despite this widespread use of technology, there are no apps designed specifically to reduce harm in people who inject drugs. The objective of this study is to analyze the development and usability testing process for an application for mobile devices, designed to complement the Needle Exchange Program. This app-the first of its kind-was developed by a public health agency, specialized professionals and people who inject drugs. We analyzed the differences in how health providers and drug users experienced the usability of the app. The participants were 61 members of multidisciplinary professional group and 16 people who inject drugs. We used a cross-sectional quantitative, observational design. First, we created and administered a questionnaire to collect the sociodemographic characteristics that could mediate the use of technology. Next participants tried the app and filled out a second questionnaire in which they rated their experience on a Likert scale from 1 to 7 in the following dimensions: overall attractiveness of the app, ease/difficulty of use, the extent to which they believed the app could improve access to injection materials, the extent to which they thought it would improve PWID's participation in the needle exchange program, overall utility, the degree to which they thought PWID would use the app, and the need for the app. To analyze the answers, we used contingency tables and compared means using a Student's t test. Finally, we conducted six audio-recorded focus groups about how the participants experienced the usability of the app. The objective of this part of the study was to classify and quantify the contributions of individuals and the group according to three predefined categories: potential benefits and positive aspects, potential obstacles or difficulties in carrying out the project, and concrete suggestions for improving the interface. There were not significant differences between the sociodemographic variables and the variables related to use of the app between professionals and PWID. Both professionals and PWID rated the app as intuitive and useful, especially the geolocation function for NEPs. Both groups also thought that the interface contained too much information and that this excess could be confusing for users. Both groups also had similar opinions about the app and its uses. An important difference between the two groups is that PWID reported that they would use the app, while professionals reported that they didn't think PWID would use it. All participants proposed improvements on the prototype, suggestions that will be applied in the creation of the definitive interface. Including professionals and patients in this sort of usability test enables researchers and developers to detect the needs of potential app users.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Health information seeking behaviour using mobile devices among people with diabetes: A comparison between Middle and high income country

Objective

The internet has become a primary source of information for many individuals especially those with chronic diseases. This study aims to understand and compare the health seeking behaviour using mobile devices among individuals with diabetes and between a high (Singapore) and middle (Malaysia) income country.

Methods

A cross sectional survey was conducted among people with diabetes in Malaysia and Singapore. Participants attending the primary health clinic for the treatment of diabetes were approached to participate in this survey. Data on demographics, health status and beliefs to health were collected and compared.

Results

A total of 673 respondents were included in the study. Most of the respondents reported to have access to the Internet, with a high ownership of mobile phones (99.3%). However, only one in every three respondents sought information online. Younger individuals (≤50 years) and those with higher education more likely to seek information using mobile devices. Respondents in Singapore reported to be more likely to use mobile devices to monitor their health as compared to respondents in Malaysia. However, most respondents would seek health information from their healthcare professionals’ especially physicians.

Conclusion

There was limited differences in the health-seeking behaviour among the respondents from both countries, suggesting for a need to identify for more effective means of distribution of health related information.

Social and Demographic Patterns of Health-Related Internet Use Among Adults in the United States: A Secondary Data Analysis of the Health Information National Trends Survey

National surveys of U.S. adults have observed significant increases in health-related internet use (HRIU), but there are documented disparities. The study aims to identify social and demographic patterns of health-related internet use among U.S. adults. Using data from the Health Information National Trends Survey (HINTS) 4 cycle 3 and HINTS 5 cycle 1, we examined HRIU across healthcare, health information seeking, and participation on social media. Primary predictors were gender, race/ethnicity, age, education, income, and nativity with adjustments for smoking and survey year. We used multivariable logistic regression with survey weights to identify independent predictors of HRIU. Of the 4817 respondents, 43% had used the internet to find a doctor; 80% had looked online for health information. Only 20% had used social media for a health issue; 7% participated in an online health support group. In multivariable models, older and low SES participants were significantly less likely to use the internet to look for a provider, use the internet to look for health information for themselves or someone else, and less likely to use social media for health issues. Use of the internet for health-related purposes is vast but varies significantly by demographics and intended use.

Impact of Trust and Privacy Concerns on Technology Acceptance in Healthcare: An Indian Perspective

This paper augments the technology acceptance model (TAM) by empirically investigating the influence of behavioral traits (privacy concerns and trust) and cognitive beliefs (perceived usefulness and perceived ease of use) on patients' behavioral intention to accept technology in healthcare service delivery. Despite increased emphasis on healthcare service delivery, there has been limited studies as to how various behavioral constructs are related to adoption of new technology in healthcare sector. To this end, and to develop meaningful insights, a conceptual model integrating behavioral constructs with constructs related to technology acceptance model is devised. The aim here is essentially to understand relationships that predict patients' acceptance of technology in healthcare services. The devised model is tested on responses obtained from survey of 416 patients availing healthcare service at various primary health centers in New Delhi, India. Structural equation modeling (SEM) is employed to conceptualize the model and validate nine hypotheses entailing key constructs. The results indicate that perceived usefulness, perceived ease of use, trust and privacy concern are direct predictors of patients' behavior to accept technology in availing healthcare services. In summary, this research provides an empirical contribution to the literature on effect of trust and privacy concerns on acceptance of technology in healthcare.

The Influence of Offline and Online Intrinsic Motivations on Online Health Information Seeking

We examine how intrinsic motivations in two health interaction contexts - online and doctor's office visit - influence online health information seeking (OHIS). Many studies have approached OHIS through short-term gratification of informational needs. Our study uses a conceptual framework of intrinsic human motivation to better understand OHIS as a form of sustained behavior. We applied Self Determination Theory's three key constructs (Autonomy, Competence, and Relatedness) within a locus of patient-physician relations. Our findings, based on a survey of 993 online health information seekers in India, show that support for Autonomy in the online context explains all three categories of OHIS behaviors: Diagnosis and Treatment Information Seeking, General Health Information Seeking, and Office Visit Information Seeking. Support for Relatedness in the online context explains only Office Visit Information Seeking. However, support for Autonomy, Competence, and Relatedness in the office visit experience could not explain why people engage in OHIS overall. Motivations for the office visit are not associated with the online experience, suggesting that online and offline are not just two kinds of substitute health interaction contexts.

Exploring Health Information Sharing Behavior of Chinese Elderly Adults on WeChat

WeChat has increasingly become an important platform for users to acquire and share health information in China. However, little is known about elderly adults' sharing behavior. This study aims to explore the characteristics and influencing factors of health information sharing behavior among Chinese older adults on WeChat, with the method both of questionnaire survey (N = 336) and in-depth interviews (N = 40). The study finds that sharing health information, mainly represented by four specific methods of forwarding, consulting, replying, and posting, has become an important part of the daily life of elderly adults on WeChat. Social media provide a good opportunity for the flow of health information. However, the purpose to share health information of Chinese older adults is mainly based on relationship maintenance more than real information support; they share health information to friends and relatives first, then to spouses and children, which does not follow the trust model as usual. Experience in online health information, authority orientation, and relationship orientation is positively associated with health information sharing behavior, however, there is no significant correlation between perceived health information credibility and health information sharing behavior. Moreover, social and cultural factors are the important explanation mechanism.

Lifestyle Segmentation to Explain the Online Health Information-Seeking Behavior of Older Adults: Representative Telephone Survey

Background

As a result of demographic changes, the number of people aged 60 years and older has been increasing steadily. Therefore, older adults have become more important as a target group for health communication efforts. Various studies show that online health information sources have gained importance among younger adults, but we know little about the health-related internet use of senior citizens in general and in particular about the variables explaining their online health-related information–seeking behavior. Media use studies indicate that in addition to sociodemographic variables, lifestyle factors might play a role in this context.

Objective

The aim of this study was to examine older people’s health-related internet use. Our study focused on the explanatory potential of lifestyle types over and above sociodemographic variables to predict older adults’ internet use for health information.

Methods

A telephone survey was conducted with a random sample of German adults aged 60 years and older (n=701) that was quota-allocated by gender, age, educational status, and degree of urbanity of their place of residence.

Results

The results revealed that participants used the internet infrequently (mean 1.82 [SD 1.07]), and medical personnel (mean 2.89 [SD 1.11]), family and friends (mean 2.86 [SD 1.21]), and health brochures (mean 2.85 [SD 1.21]) were their main sources of health information. A hierarchical cluster analysis based on values, interests, and leisure time activities revealed three different lifestyle types for adults aged over 60 years: the Sociable Adventurer, the Average Family Person, and the Uninterested Inactive. After adding these types as second-step predictors in a hierarchical regression model with sociodemographic variables (step 1), the explained variance increased significantly (R²=.02, P=.001), indicating that the Average Family Person and the Sociable Adventurer use the internet more often for health information than the Uninterested Inactive, over and above their sociodemographic attributes.

Conclusions

Our findings indicate that the internet still plays only a minor role in the health information–seeking behavior of older German adults. Nevertheless, there are subgroups including younger, more active, down-to-earth and family-oriented males that may be reached with online health information. Our findings suggest that lifestyle types should be taken into account when predicting health-related internet use behavior.

The Process of Developing a Sleep Health Improvement Plan: a Lab-Based Model of Self-Help Behavior

BACKGROUND

Although self-help strategies to improve sleep are widely accessible, little is known about the ways in which individuals interact with these resources and the extent to which people are successful at improving their own sleep based on sleep health recommendations. The present study developed a lab-based model of self-help behavior by observing the development of sleep health improvement plans (SHIPs) and examining factors that may influence SHIP development.

METHOD

Sixty healthy, young adults were identified as poor sleepers during one week of actigraphy baseline and recruited to develop and implement a SHIP. Participants viewed a list of sleep health recommendations through an eye tracker and provided information on their current sleep health habits. Each participant implemented their SHIP for 1 week during which sleep was assessed with actigraphy.

RESULTS

Current sleep health habits, but not patterns of visual attention, predicted SHIP goal selection. Sleep duration increased significantly during the week of SHIP implementation.

CONCLUSIONS

Findings indicate that the SHIP protocol is an effective strategy for observing self-help behavior and examining factors that influence goal selection. The increase in sleep duration suggests that individuals may be successful at extending their own sleep, though causal mechanisms have not yet been established. This study presents a lab-based protocol for studying self-help sleep improvement behavior and takes an initial step toward gaining knowledge required to improve sleep health recommendations.