Health information-seeking behavior in patients with coronary artery disease: Activating methods

INTRODUCTION

Coronary artery disease (CAD) has a high mortality rate worldwide, and continuous health behavior practice and careful management are required owing to risks such as rapid changes in symptoms and emergency hospitalization. The utilization of health-related information is an important factor for long-term disease management in patients with CAD. For this purpose, an understanding of health information-seeking behavior is needed first.

METHODS

This study analyzed data from the 2021 Korea Medical Panel Survey, and logistic regression analysis was conducted to confirm the factors influencing the health information-seeking behavior of patients with CAD.

RESULTS

The health information-seeking behavior of patients with CAD differed according to demographic characteristics, and differences in preferred information use were confirmed. Finally, it was identified that insufficient levels of health literacy were a major reason for CAD patients not engaging in health information-seeking behaviors (OR, 0.17; 95% CI, 0.09-0.33; p < 0.001).

CONCLUSION

This study suggests that to improve health information-seeking behaviors, the application of education and intervention programs to increase the level of health literacy is necessary.

Investigating harms of testing for ovarian cancer - psychological outcomes and cancer conversion rates in women with symptoms of ovarian cancer: A cohort study embedded in the multicentre ROCkeTS prospective diagnostic study

OBJECTIVE

To investigate psychological correlates in women referred with suspected ovarian cancer via the fast-track pathway, explore how anxiety and distress levels change at 12 months post-testing, and report cancer conversion rates by age and referral pathway.

DESIGN

Single-arm prospective cohort study.

SETTING

Multicentre. Secondary care including outpatient clinics and emergency admissions.

POPULATION

A cohort of 2596 newly presenting symptomatic women with a raised CA125 level, abnormal imaging or both.

METHODS

Women completed anxiety and distress questionnaires at recruitment and at 12 months for those who had not undergone surgery or a biopsy within 3 months of recruitment.

MAIN OUTCOME MEASURES

Anxiety and distress levels measured using a six-item short form of the State-Trait Anxiety Inventory (STAI-6) and the Impact of Event Scale - Revised (IES-r) questionnaire. Ovarian cancer (OC) conversion rates by age, menopausal status and referral pathway.

RESULTS

Overall, 1355/2596 (52.1%) and 1781/2596 (68.6%) experienced moderate-to-severe distress and anxiety, respectively, at recruitment. Younger age and emergency presentations had higher distress levels. The clinical category for anxiety and distress remained unchanged/worsened in 76% of respondents at 12 months, despite a non-cancer diagnosis. The OC rates by age were 1.6% (95% CI 0.5%-5.9%) for age <40 years and 10.9% (95% CI 8.7%-13.6%) for age ≥40 years. In women referred through fast-track pathways, 3.3% (95% CI 1.9%-5.7%) of pre- and 18.5% (95% CI 16.1%-21.0%) of postmenopausal women were diagnosed with OC.

CONCLUSIONS

Women undergoing diagnostic testing display severe anxiety and distress. Younger women are especially vulnerable and should be targeted for support. Women under the age of 40 years have low conversion rates and we advocate reducing testing in this group to reduce the harms of testing.

Motivation as a Lens for Understanding Information-seeking Behaviors

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

Profiling Cancer Patients Based on Their Motives for Seeking Informational and Emotional Support Online

Understanding why patients seek informational and/or emotional support online is fundamental to providing patients with accurate and reliable support that is tailored to their needs, preferences, and personal situation. Based on the stress and coping theory and uses and gratifications theory (UGT), this study aimed to identify theoretically-founded profiles of cancer patients differing in their motives for seeking informational and/or emotional support online, and to compare the profiles in terms of patients' psychological and background characteristics, and perception of health care services. Hierarchical cluster analysis was conducted, using questionnaire data from patients visiting a large Dutch health website (N = 181). This revealed three distinctive profiles, i.e., overall seekers (n = 83, 46.0%), occasional information seekers (n = 83, 46.0%), and contact exchangers (n = 15, 8.0%). Patients across these profiles differed in their eHealth literacy, with the contact exchangers being more eHealth literate than the overall seekers and occasional information seekers. The results can be used to create awareness among health care providers, web designers, and patient organizations on different types of cancer patients with different motives for seeking informational and/or emotional support online, and help them to tailor recommendations to and development of (online) sources that fit patients' needs. Future research could further investigate the integration of stress and coping theory with UGT by acknowledging the interplay of different coping strategies and different gratifications.

Is There a Relationship Between Online Health Information Seeking and Health Anxiety? A Systematic Review and Meta-Analysis

The internet has revolutionized how we live, providing unprecedented convenience and up-to-date information. Consequently, an increasing number of individuals are turning to the internet for health-related information, despite research suggesting a correlation between this behavior and health anxiety. Therefore, drawing on cognitive - behavioral theory, we explore the link between online health information seeking and health anxiety via a systematic review and meta-analysis of cross-sectional studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis, we ran searches in multiple databases, including PubMed, Web of Science, Embase, Elsevier/Science Direct, Cochrane Database, China National Knowledge Infrastructure, VIP Chinese Database, and Wanfang Data. Our searches identified 16 studies eligible for review, involving 4,920 participants across seven countries. The random-effects meta-analysis revealed a significant positive correlation between online health information seeking and health anxiety (r = 0.28, 95% confidence interval [0.16, 0.41], p < .0001), despite considerable heterogeneity. Furthermore, meta-regression analysis demonstrated that the identity characteristics of the sample, female percentage, sample size, and country all contributed to the heterogeneity across studies. Overall, this meta-analysis provides support for the association between online health information seeking and health anxiety, and helps to elucidate the cognitive - behavioral theory underpinning this phenomenon.

Influence of mental health on information seeking, risk perception and mask wearing self-efficacy during the early months of the COVID-19 pandemic: a longitudinal panel study across 6 U.S. States

BACKGROUND

Understanding factors that influence information seeking, assessment of risk and mitigation behaviors is critical during a public health crises. This longitudinal study examined the influence of self-reported mental health during the early months of the COVID-19 pandemic on information seeking, risk perception and perceived mask wearing ability. Mental health screener items included fear, anger, and hopelessness in addition to avoidance, diminished functional ability and global distress. Theoretical models inform hypotheses linking mental health items and outcomes.

METHODS

The research employed a longitudinal 6-state 3-wave online panel survey, with an initial sample of 3,059 participants (2,232 included in longitudinal analyses). Participants roughly represented the states' age, race, ethnicity, and income demographics.

RESULTS

Women, those who identified as Hispanic/Latinx, Black Americans and lower income participants reported higher overall rates of distress than others. Information seeking was more common among older persons, Democrats, retirees, those with higher education, and those who knew people who had died of COVID-19. Controlling for such demographic variables, in multivariable longitudinal models that included baseline mental health measures, distress and fear were associated with increased information seeking. Distress and fear were also associated with increased risk perception, and feelings of hopelessness were associated with lower reported mask-wearing ability.

CONCLUSIONS

Results advance understanding of the role mental health can play in information seeking, risk perception and mask wearing with implications for clinicians, public health practitioners and policy makers.

Online health information seeking and the association with anxiety among older adults

Introduction

The Internet supplies users with endless access to a wealth of information and is generally the first source searched by U.S. adults (18 years and older) when seeking health information. Age and anxiety are associated with online health information seeking (OHIS). Older adults (65 years and older) are increasing their OHIS. Importantly, OHIS can potentially lead to improved health outcomes for older adults. The relationship between OHIS and anxiety is less clear. Studies report those with more symptoms of anxiety are more likely to be OHIS, while other studies find the reverse pattern or no association. Generalized anxiety disorder affects up to 11% of older adults and is oftentimes unrecognized and untreated.

Methods

To address the mixed findings in the literature, we analyzed six waves (2015-2020) of data from the National Health and Aging Trends Study to assess the causal relationship between anxiety and OHIS using a Random Intercept Cross-lagged Panel Model framework.

Results

We found that while anxiety symptoms lead to OHIS in the next wave, OHIS was not associated with anxiety symptoms in the next wave.

Discussion

This suggests that for this sample of older adults, OHIS does not reduce or exacerbate older adults' symptoms of anxiety.

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

Objective

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

Methods

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

Results

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

Conclusions

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

Research on hotspots and evolution paths in the field of health information behavior: a comparison study of bibliometrics based on CNKI and WoS data

Purpose

This study aimed to examine the research hotspots and evolution paths in the field of health information behavior (HIB) in China and abroad, and conduct comparative analysis to better understand its development trajectory globally.

Design/methodology/approach

A keyword search of the relevant literature included in the China National Knowledge Infrastructure (CNKI) database and Web of Science (WoS) core collection database was conducted, using the visualized analysis tool CiteSpace V for bibliometric analyses.

Findings

The common research hotspots in China and abroad can be divided into related research on HIB, research on its influencing factors and health information research. Among these, health information-seeking behavior has been the focus of domestic and foreign scholars. From the subdivision perspective, the focus of Chinese and foreign research hotspots differs. In terms of evolutionary path, the initial stage of HIB research in China and abroad revolves around health information and health information-seeking behavior, followed by the influencing factors of HIB; however, the research breakthrough point is the reverse. Then, domestic and foreign research was conducted on different types of HIBs. Regarding the selection of research objects, Chinese and foreign research objects were increasingly diversified.

Research limitations/implications

This study also has several limitations. First, the literature sample only selected the literature in the WoS and CNKI databases, and there may be many HIB-related works published in other databases. Therefore, future research should include other databases. Second, in terms of language, this study selected only Chinese and English literature, but in many countries, important research results on certain topics are usually published in native language, and future research should expand the language selection. Third, this study only conducted national and institutional collaboration network analysis, keyword co-occurrence analysis, cluster analysis and timeline chart analysis.

Practical implications

The implication of practice can be divided into the following three points. (1) Analyzing the domestic and foreign literature on HIB and identifying highly cooperative institutions and countries in the field of HIB can reveal the research situation of HIB and help researchers establish new research networks in the future. (2) Analyzing the research hotspots and evolutionary paths of HIB at home and abroad is helpful for quickly understanding the development context of this field and grasping the emerging research directions such as HIB of people in close contact with patients, health information exchange behavior, health information avoidance behavior and health information discontinuation behavior, which can help researchers to explore the future research direction in this field, so as to determine the topic and fill the research gap. (3) Combining the analysis of HIB-related research at home and abroad is helpful for professionals to understand the characteristics and rules of HIB of users, consumers and other groups to further optimize and improve health information services.

Originality/value

Comparing and summarizing the research status of HIB in China and globally, and presenting the findings visually, will help researchers better grasp the research overview and hotspot changes in this field, as well as provide a follow-up reference.

Determining health information-seeking behavior of shoulder patients

BACKGROUND

Patients today have access to an increasing number of health resources to guide medical decision making, including specialist health care providers, the Internet, friends, and family members. No prior studies, to our knowledge, have comprehensively explored health information-seeking behavior (HISB) for patients being managed for shoulder pain.

OBJECTIVE

Our primary objective is to identify which health resources patients use and find helpful in a cohort of patients being either evaluated or managed for shoulder pain. With increased access to the Internet and its use, we also hope to quantify the extent of use of Internet resources and identify predictors of patient use.

METHODS

We interviewed a cohort of new and follow-up patients being surgically or nonoperatively managed for shoulder pain by a single fellowship-trained orthopedic surgeon. All patients were administered a questionnaire to determine HISB, which evaluated the types of resources used and those deemed most helpful in guiding medical decision making. For patients using the Internet, specific websites were documented. Additional variables that were collected included age, gender, ethnicity, and highest education attained. Multivariable logistic regression was used to evaluate predictors of Internet use.

RESULTS

This study included 242 patients. A discussion with an orthopedic surgeon was reported to be the most informative for nonoperatively treated patients, first postoperative patients, and operative follow-up patients. Patients at the first postoperative visit reported YouTube as their preferred resource almost 4 times more than new patients (odds ratio [OR] 3.9, P = .015). Search engine use was significantly higher in patients at the first postoperative visit (OR 5.8, P = .004) and patients at subsequent surgical follow-up (OR 8.3, P = .001) compared with new patients. Having an undergraduate (OR 0.1, P = .037) or graduate degree (OR 0.03, P = .01) had a significant inverse association with difficulty of using Internet resources. Patients of Black race reported significantly higher rates of distrust for Internet resources than those of White race (OR 5.8, P < .001).

CONCLUSION

This study highlights the patterns of HISB among patients with shoulder conditions. A face-to-face discussion with a physician or a shoulder surgeon was the most crucial resource for information compared to other resources. This study has also defined the preferred Internet resources for patients at different time points of care and the reasons for refraining from seeking health information on the Internet. Such findings can aid shoulder surgeons in understanding the optimal methods for delivering health information for different patient demographics and different phases of their care.

Participant Engagement and Reactance to a Short, Animated Video About Added Sugars: Web-based Randomized Controlled Trial

Background

Short, animated story-based (SAS) videos are a novel and promising strategy for promoting health behaviors. To gain traction as an effective health communication tool, SAS videos must demonstrate their potential to engage a diverse and global audience. In this study, we evaluate engagement with a SAS video about the consumption of added sugars, which is narrated by a child (a nonthreatening character), a mother (a neutral layperson), or a physician (a medical expert).

Objective

This study aims to (1) assess whether engagement with the sugar intervention video differs by narrator type (child, mother, physician) and trait proneness to reactance and (2) assess whether the demographic characteristics of the participants (age, gender, education status) are associated with different engagement profiles with the sugar intervention video.

Methods

In December 2020, after 4013 participants from the United Kingdom completed our randomized controlled trial, we offered participants assigned to the placebo arms (n=1591, 39.65%) the choice to watch the sugar intervention video (without additional compensation) as posttrial access to treatment. We measured engagement as the time that participants chose to watch the 3.42-minute video and collected data on age, gender, education status, and trait reactance proneness. Using ordinary least squares regression, we quantified the association of the demographic characteristics and trait reactance proneness with the sugar video view time.

Results

Overall, 66.43% (n=1047) of the 1576 participants in the 2 placebo arms voluntarily watched the sugar intervention video. The mean view time was 116.35 (52.4%) of 222 seconds. Results show that view times did not differ by narrator (child, mother, physician) and that older participants (aged 25-59 years, mean = 125.2 seconds) watched the sugar video longer than younger adults (aged 18-25 years, mean = 83.4 seconds). View time remained consistent across education levels. Participants with low trait reactance (mean = 119.3 seconds) watched the intervention video longer than high-trait-reactance participants (mean = 95.3 seconds), although this association did not differ by narrator type.

Conclusions

The majority of participants in our study voluntarily watched more than half of the sugar intervention video, which is a promising finding. Our results suggest that SAS videos may need to be shorter than 2 minutes to engage people who are young or have high trait proneness to reactance. We also found that the choice of narrator (child, mother, or physician) for our video did not significantly affect participant engagement. Future videos, aimed at reaching diverse audiences, could be customized for different age groups, where appropriate.

Trial Registration

German Clinical Trials Register DRKS00022340; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022340

International Registered Report Identifier (IRRID)

RR2-10.2196/25343

Social Media and the Transformation of the Physician-Patient Relationship: Viewpoint

As many as 80% of internet users seek health information online. The social determinants of health (SDoH) are intimately related to who has access to the internet and health care as a whole. Those who face more barriers to care are more likely to benefit from accessing health information online, assuming the information they are retrieving is accurate. Virtual communities on social media platforms are beginning to serve as venues for seeking health information online because peers have been shown to influence health behavior more than almost anything else. As a positive mediator of health, social media can be used as a direct or indirect mode of communication between physicians and patients, a venue for health promotion and health information, and a community support network. However, false or misleading content, social contagion, confirmation bias, and security and privacy concerns must be mitigated to realize the full potential of social media as a positive mediator of health. This paper presents the shifting dynamics of how such communities are affecting physician-patient relationships. With the intersections between the SDoH, social media, and health evolving, physicians must take into consideration these factors when establishing their relationships with patients. We argue a paradigm shift in the physician-patient relationship is warranted, one where physicians acknowledge the impacts of the SDoH on information-seeking behavior, recognize the positive and negative roles of social media as a mediator of health through the lens of the SDoH, and use social media to catalyze positive changes in the physician-patient relationship. We discuss how the physician-patient relationship must evolve to accommodate for the ever-increasing role of social media in health and to best use social media as a tool to improve health outcomes. Finally, we present a fluid and multicomponent diagram that we believe will assist in framing future research in this area. We conclude that it is ineffective and even counterproductive for physicians to ignore the relationship between social media, the SDoH and health, their impact on one another, and the effect it has on designing the medical encounter and the delivery of care under the definition of precision medicine.

Online Health Information-Seeking Behavior Among Korean American Immigrants in Rural Alabama: Dose Discrimination Matter?

Little attention has been paid to online health information seeking (OHIS) among immigrants residing in rural areas. This study examines the intensity of OHIS among Korean American (KA) immigrants living in rural Alabama. A total number of 261 KA immigrants aged 23 to 75 participated in the study. Multiple linear regression analyses were conducted. Age (B = - 0.044, p < 0.05), marital status (B = 1.132, p < 0.05), race/ethnic discrimination (B = 0.821, p < 0.05), having computer or tablet (B = 1.286, p < 0.05), and access to internet (B = 1.778, p < 0.01) were associated with the intensity of OHIS. Substantial efforts should be devoted to narrowing the access gap by providing offline health information services for those without internet access and with limited health literacy. Moreover, culturally competent healthcare services and information should be provided to serve racial/ethnic minority populations better.

The Role of Discrete Emotions in Risk Perception and Policy Support during Public Health Crises: The Moderation Effect of SNS Dependency

People often experience strong emotions during public health crises. This study examines how these emotions shape the perception of risk and support for policies to address the risk. In particular, this study explores the moderating effects of social network services (SNS) use in the process, considering that SNS have become a prominent communication platform during crises. Using a nationwide online survey conducted on the issue of fine dust air pollution in South Korea, this study found that feelings of anxiety, anger, and sadness about the risk issue were positively related to risk perception and policy support, while the relative effects of these emotions varied. Furthermore, the results demonstrated that reliance on SNS for learning (i.e., SNS learning dependency) moderated the influence of anxiety: the positive impact of anxiety was greater among those who used SNS for learning, while no such effects were found among those who used SNS for play or entertainment (i.e., SNS entertainment dependency). The implications of this study are discussed in terms of the distinct role emotions play in public responses to risks and the importance of considering the impact of SNS on public perceptions and judgments in this era of social media.

Human information behavior during the Covid-19 health crisis. A literature review

The research carried out on human information behavior (HIB) during the Covid-19 health crisis was reviewed, with the premise that HIB and information practices allow humans to adapt to the changing circumstances of existence. A literature search was run on the LISTA and Google Scholar databases from middle March 2020 up to the end of March 2021. After filtering retrieved results, 52 studies were selected. Results are summarized into seven main themes, including the use of traditional and social media, infoveillance of search engines and social media activity, misinformation, disinformation and infodemics, and uncertainty and emotions. Results point to the need to carry out additional research in specific contexts and addressing vulnerable and marginalized groups. Further areas of inquiry include the interplay of emotions, knowledge and behaviors during the information seeking process, a better understanding of local knowledge and experiential knowledge, and the need to comprehend the limitations of ICT.

The Impact of Emotion and Government Trust on Individuals' Risk Information Seeking and Avoidance during the COVID-19 Pandemic: A Cross-country Comparison

This study examines the emotional mechanisms of how public trust in the governments' actions to address the COVID-19 pandemic shapes individuals' risk information-seeking and avoidance. To make cross-cultural comparisons, we conducted a multi-country survey early in the pandemic in South Korea, the United States (US) and Singapore. The results suggest that trust was negatively related to fear, anger, sadness and anxiety, and positively related to hope. These emotions were significant mediators of the effect of trust on information seeking and avoidance, except for anger on avoidance. Importantly, the indirect effects of trust in government varied by country. Fear was a stronger mediator between trust and information seeking in South Korea than in the US. In contrast, sadness and anger played more prominent mediating roles in Singapore than in South Korea. This study offers theoretical insights into better understanding the roles of discrete emotions in forming information behaviors. The findings of this study also inform communication strategies that seek to navigate trust in managing pandemics that impact multiple nations.

Prevalence of anger, engaged in sadness: engagement in misinformation, correction, and emotional tweets during mass shootings

Purpose

The goal of this study is to examine how tweets containing distinct emotions (i.e., emotional tweets) and different information types (i.e., misinformation, corrective information, and others) are prevalent during the initial phase of mass shootings and furthermore, how users engage in those tweets.

Design/methodology/approach

The researchers manually coded 1,478 tweets posted between August 3–11, 2019, in the immediate aftermath of the El Paso and Dayton mass shootings. This manual coding approach systematically examined the distinct emotions and information types of each tweet.

Findings

The authors found that, on Twitter, misinformation was more prevalent than correction during crises and a large portion of misinformation had negative emotions (i.e., anger, sadness, and anxiety), while correction featured anger. Notably, sadness-exhibiting tweets were more likely to be retweeted and liked by users, but tweets containing other emotions (i.e., anger, anxiety, and joy) were less likely to be retweeted and liked.

Research limitations/implications

Only a portion of the larger conversation was manually coded. However, the current study provides an overall picture of how tweets are circulated during crises in terms of misinformation and correction, and moreover, how emotions and information types alike influence engagement behaviors.

Originality/value

The pervasive anger-laden tweets about mass shooting incidents might contribute to hostile narratives and eventually reignite political polarization. The notable presence of anger in correction tweets further suggests that those who are trying to provide correction to misinformation also rely on emotion. Moreover, our study suggests that displays of sadness could function in a way that leads individuals to rely on false claims as a coping strategy to counteract uncertainty.

Peer review

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-03-2021-0121/

The Influence of Online Health Information Seeking Before a Consultation on Anxiety, Satisfaction, and Information Recall, Mediated by Patient Participation: Field Study

BACKGROUND

Today, many cancer patients engage in online health information seeking (OHIS). However, little is known about how patients differ in their OHIS levels. In addition, OHIS might influence patient participation during a consultation with a physician, which might mediate the effects on patient outcomes.

OBJECTIVE

The aim of this study is twofold: first, to provide insight into which personal characteristics and psychosocial factors affect patients' OHIS levels and, second, to test the hypothesis that the effects of OHIS on patient outcomes are mediated by patient participation during the consultation.

METHODS

Patient participation was operationalized in terms of patients' absolute word count; the relative contribution of the patient, compared with the health care provider; and the number of questions and assertions expressed during the consultation. The patient outcomes measured were anxiety after the consultation, satisfaction with the consultation, and information recall. Participants in this study were patients recently diagnosed with colorectal cancer recruited from 6 hospitals in the Netherlands (n=90). Data were collected using questionnaires and audio-recorded consultations of patients with health care providers before their surgery.

RESULTS

The results showed that younger patients, higher educated patients, patients with a monitoring coping style, and patients who experienced more cancer-related stress engaged more in OHIS. In turn, OHIS was related to patient participation in terms of the patient's absolute word count but not to the relative contribution to the consultation or expressing questions and assertions. We did not find a relation between OHIS and anxiety and OHIS and recall mediated by patient participation. However, we found that patients' absolute word count significantly mediated the positive association between OHIS and patients' satisfaction with the consultation.

CONCLUSIONS

Results indicate positive implications of OHIS for patients' care experience and, therefore, the importance of helping patients engage in OHIS. However, the results also suggest that OHIS is only successful in increasing a single aspect of patient participation, which might explain the absence of relations with anxiety and recall. The results suggest that more beneficial effects on patient outcomes may be achieved when health care providers support patients in OHIS.

Women's Health Information Survey: Common Health Concerns and Trusted Sources of Health Information Among Different Populations of Female Patients

Background: Women are more likely to search for information on behalf of both themselves and others, thus making them a valuable target for health information research. The purpose of this project was to identify and compare the most important medical concerns and sources of health information trusted by women in relationship to demographic differences in two different clinical settings within the same geographic area (Mayo Clinic Department of Family Medicine and Beaches Community Health care—a Sulzbacher Center Clinic).

Methods: A novel survey tool was developed to obtain information regarding the age, race, and socioeconomic demographics of patients as well as the patients' personal significant medical concerns and trusted sources of health information.

Results: Despite the huge development of health care information delivery through online resources, in our study, the majority of patients from both clinics still used and viewed their primary care provider as the most trusted source of health information. The health concerns most reported by both populations included cardiac health, breast and other cancers, and obesity; meanwhile, mental health was significantly more reported by patients from the free clinic.

Conclusions: Education level may be an important factor of the awareness and ultimate treatment and prevention of these prevalent diseases. Furthermore, our study results may help improve patient satisfaction, knowledge, and health outcomes.

Prevalence of Risk Factors Associated With Mental Health Symptoms Among the Outpatient Psychiatric Patients and Their Family Members in China During the Coronavirus Disease 2019 Pandemic

Objective: To investigate the prevalence of and risk factors associated with mental health symptoms in psychiatric outpatients and their family members in China during the COVID-19 pandemic.

Methods: This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements for depression, anxiety and acute stress from 269 psychiatric patients and 231 family members in the Second Xiangya Hospital in China from April 27, 2020 to May 8, 2020. Binary logistic regression analysis was performed to identify risk factors associated with mental health outcomes.

Result: The results of this survey revealed that symptoms of depression, anxiety, and acute stress were highly prevalent symptoms in the psychiatric patient group. Respondents who were female, unmarried or highly educated were significantly more likely to have the above symptoms. In the family member group, more than half of them felt that the burden of nursing had increased during the epidemic. Subjects with a high degree of burden of care were significantly more likely to exhibit the above mental health symptoms, while females were significantly more likely to have acute stress.

Conclusions: The results of this survey revealed a high prevalence of mental health disorder symptoms among psychiatric patients and an increased burden of nursing among their family members after the COVID-19 outbreak in China. Understanding the risk factors in those particular groups of people help improve the public health service system for mental health problems during public health events. For further study, exploration of the needs of mental health services and dynamic change tracking will be needed.

Factors Influencing Anxiety Among WeChat Users During the Early Stages of the COVID-19 Pandemic in Mainland China: Cross-sectional Survey Study

BACKGROUND

The rapid outbreak of COVID-19 around the world has adversely affected the mental health of the public. The prevalence of anxiety among the public has increased dramatically during the COVID-19 pandemic. However, there are few studies evaluating the effects of positive psychological responses and information-seeking behaviors on anxiety experienced among social media users during the COVID-19 pandemic.

OBJECTIVE

This study evaluated the prevalence of anxiety and its associated factors among WeChat users in mainland China during the early stages of the COVID-19 pandemic.

METHODS

From February 10 to February 24, 2020, a nationwide, web-based cross-sectional survey study was carried out using convenience sampling. Participants' levels of anxiety, positive psychological responses, and information-seeking behaviors were assessed. The survey was distributed among WeChat users via the WeChat smartphone platform. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with anxiety.

RESULTS

This study found that the prevalence of anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale score ≥7) among WeChat users in China was 17.96% (446/2483) during the early stages of the COVID-19 pandemic. Results of multivariable logistic regression analysis showed that information-seeking behaviors such as cannot stop searching for information on COVID-19, being concerned about the COVID-19 pandemic, and spending more than 1 hour per day consuming information about the pandemic were found to be associated with increased levels of anxiety. Additionally, participants who chose social media and commercial media as the primary sources to obtain information about the COVID-19 pandemic were found more likely to report anxiety. Conversely, participants who were confident or rational about the COVID-19 pandemic were less likely to report anxiety.

CONCLUSIONS

This study found that positive psychological responses and information-seeking behaviors were closely associated with anxiety among WeChat users during the COVID-19 pandemic in China. It might be paramount to enhance mental well-being by helping people respond to the COVID-19 pandemic more rationally and positively in order to decrease symptoms of anxiety.

Anxiety and COVID-19: A study of online content readability

The uncertain and unprecedented nature of the COVID-19 pandemic is anxiety-provoking and some people are seeking information about this anxiety online. The purpose of this study was to assess the readability levels of online articles related to anxiety and COVID-19. The first 50 English language URLs to appear in a Google search in July 2020 were assessed for readability using Readable.io. A five-measure panel consisting of the Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index, Coleman-Liau Index (CLI), the Simple Measure of Gobbledygook (SMOG) Grade Level, and Flesch-Kincaid Reading Ease (FRE) was used, and grade level scores were recoded as easy, average, and difficult readability. Websites were grouped as commercial vs. noncommercial sources bases on the URL. Of the 50 articles evaluated, the majority were found to be written at a difficult (>10th grade) reading level with four of the five measures employed which is well above the 7-8th grade reading level abilities of most Americans. Given the importance of access to mental health information during the pandemic, it is crucial that the resources available to the general public are written at a reading level that is comprehensible to ensure they are understood.

Stopping healthcare misinformation: The effect of financial incentives and legislation

Fake news and misinformation have become a major social issue. And yet, many researchers concern primarily about political misinformation, leaving healthcare misinformation less emphasized. Nevertheless, healthcare misinformation may create consequences such as delayed diagnosis or treatment of patients or even public health crisis. We conducted an online experiment to test the role of financial incentives and legislation on disseminating online healthcare misinformation. Our findings revealed that financial incentives have a positive but diminishing impact on the likelihood of sharing online healthcare information regardless of validity. However, financial incentives have a stronger impact on attracting readers to share healthcare misinformation that they perceived to be fake. Surprisingly, legislation may deter the sharing of healthcare information that users perceive to be true but cannot deter them from sharing the healthcare misinformation they perceive to be fake. We also provided some practical implications for formulating measures of battling against healthcare misinformation for policymakers.

Exploring sociodemographic predictors of parents' perceptions about their children's autism and their families' adjustment

BACKGROUND

Diagnostic and treatment disparities exist among sociodemographically diverse families with autism spectrum disorder (ASD). These disparities may be partially explained by the lack of information researchers and providers have regarding the unique experiences of diverse populations.

AIMS

This study aimed to explore sociodemographic predictors of parents' perceptions about their children's ASD and families' adjustment.

METHODS

Hierarchical linear regression analyses were conducted to explore whether sociodemographic factors predicted aspects of parent's perceptions and family adjustment among 363 parents of children and adolescents with ASD.

RESULTS

Parents' race/ethnicity, education level, and annual household income predicted their beliefs that they or treatment could be helpful in controlling their children's ASD symptoms; their understanding of ASD; their experiences of emotional distress; their involvement in resources of support; and their families' ability to manage stress.

CONCLUSION

Our results demonstrate the importance of considering the complexity of families' demographic characteristics when working to support families with ASD. Parents' unique characteristics and experiences influence their perceptions about their children's ASD diagnosis and their families' ability to adjust to life raising children with ASD. Research extending this work is a critical step in dismantling ASD diagnostic and treatment disparities.

The Impact of New Technologies on Individuals’ Health Perceptions in the European Union

The healthcare systems of European countries currently face challenges regarding the sustainability of healthcare provision. The growing sophistication of new technologies is transforming the accessibility and management of health services and information, while also challenging society’s ability to offer fair access to health services for all people. The aim of this paper is to identify and analyze some of the determinants of the self-perceived health status across the EU28 area and to determine how the digitalization of health is impacting the self-rated health of the European populations, given the fact that a healthier population is one of the 17 goals of sustainable development on the 2030 Agenda. The research method used is panel-data regression using secondary data from international databases. The results indicate that there is a direct relationship between the way people are assessing personal health, the ability to use the Internet for seeking health-related information, and the use of various apps to purchase health-related items online. Our findings are useful for academics, industry specialists, and public authorities in designing sustainable health products and policies by focusing on the development of suitable mHealth programs for generating more patient-centered services where the idea of self-care is encouraged.

Rethinking the Role of Affect in Risk Judgment: What We Have Learned From COVID-19 During the First Week of Quarantine in Italy

Due to COVID-19 spreading in Italy, on March 11 the Prime Minister of Italy declared a lockdown and imposed severe restrictive measures impacting citizens’ freedom at several levels. People were required to stay at home and go out only to satisfy basic needs. Several risk models have postulated a link among online searching behavior, affect, anxiety, and complaints by individuals toward government restrictions (GR), which emerged as also related to an increased perception of knowledge toward risk. However, to date, no study has addressed how these key risk-related aspects (i.e., affect, anxiety, perceived knowledge on risk, and risk dimensions) can act jointly to orient online health information-seeking behavior, and people’s complaints toward GR imposed during the lockdown. This study investigated the mechanisms underlying online health information-seeking behavior and people’s complaints toward the government’s restrictions during a COVID-19 emergency in the Italian population. Drawing from the health belief model (HBM), which postulates a link between sociodemographic variables, risk, and affect dimensions in emergency, we assumed risk factors as predictors of affect and anxiety, which, in turn, were posited as mediators between risk dimensions, online health information-seeking behavior, and complaints toward GR. Participants (1,031) were involved during the first week of the quarantine (March 11–18) and completed an online survey composed of (i) an adapted version of the Italian Risk Perception Questionnaire; (ii) the Italian Positive (PA) and Negative Affect (NA) Schedule (PANAS-10); (iii) the State Anxiety Scale (STAI-Y1); (iv) ad hoc personal knowledge measure about novel coronavirus; (v) ad hoc item measuring information search behavior regarding the novel coronavirus; (vi) ad hoc measure of the complains regarding GR; and (vii) sociodemographic questions. General linear models and structural equation modeling (SEM) were carried out to test the model. Sociodemographic and cognitive factors predicted the participants’ affect and anxiety, which, in turn, motivated and fully mediated both information search behavior and complaint toward GR. This research can offer useful suggestions for policy-makers during the COVID-19 emergency, and it advanced the knowledge on the risk–emotion link in emergency situations.

Is a Self-Monitoring App for Depression a Good Place for Additional Mental Health Information? Ecological Momentary Assessment of Mental Help Information Seeking among Smartphone Users

Mobile devices and apps offer promising opportunities for both patients and healthcare professionals, for example, to monitor and assess health status, and also to provide relevant health information. However, health information seeking within a mood-tracking app has not yet been addressed by research. To bridge this gap, the depression-related health information seeking of 6,675 users of a mood-tracking smartphone app was unobtrusively monitored. The study shows that self-monitored depressive symptoms are associated with higher depression-related information seeking within the app. Health information seeking was low in general, with differences across 12 depression-related topics (e.g., depressive thoughts, a depression diagnosis, or depression facts), but the findings are also promising as the smartphone app was shown to be a place where users can inform themselves about health topics related to the main purpose of the app. Smartphone apps would therefore seem to be a vehicle through which to provide additional health information about, for example, comorbidities, or pre- or post-interventions, even going beyond the original purposes of such mobile health (mHealth) monitoring apps.

Relationship based care - how general practice developed and why it is undermined within contemporary healthcare systems

Objective: Investigating the state of generalism in medicine from the outlook of general practice. Line of argument: General practice developed when its pioneers, in continuing relationships, learnt to know their patients through the variety of medical situations. From the 50s, there is an increasing literature on the virtues and challenges of relationship based general practice, and register-based research indicate its benefits. Generalist perspectives and person-centeredness are implemented in specialised care and medical education but need to be complemented by an input from relationship based general practice. The politically defined aim of primary care is not to balance the draw-backs of specialisation, but to provide medicine at the primary care level. In Sweden, and increasingly even in traditional strongholds of general practice, team-based primary care is thought to respond to increasing demands, filtering out non- and minor disease through triage, practicing task distribution, and moving the GP to a secondary level working with the 'really sick', in all a decline in direct contact between patient and GP. Conclusions: When this happens, clinical medicine as a whole becomes drained of the practice of its human dimension. The lack of absolute proof of medical benefits cannot justify a disregard of the value of mutual knowledge and trust in the relationship, but still, in several countries, relationshipbased general practice will be hard to achieve for GPs planning their career. If the political winds should change, a sustaining profession of GPs preserving their relational ethos inside the team model, may be prepared to reform primary care. KEY POINTS Proclaiming both biomedical breadth and the trustful relationship between doctor and patient, as a specialty, general practice embodies medical generalism. A direct input from the patient's personal GP is necessary to make specialised care become more comprehensive and individualised. In reality, the team, practicing triage and task distribution, is increasingly replacing the doctor-patient relationship as working mode in primary care When the disease rather than the doctor-patient relationship, becomes the organising principle of primary care, medicine as a whole will be drained of the practice of its human dimension.