A mixed methods systematic review of the effects of patient online self-diagnosing in the 'smart-phone society' on the healthcare professional-patient relationship and medical authority

Impact of mobile Internet use on health-seeking behaviors: evidence from China

Introduction

Although health-seeking behaviors are crucial to China's healthcare delivery system, the influence of mobile Internet use in this context remains under-explored. This study aimed to comprehensively explore the influence of mobile Internet use on health-seeking behaviors, and meticulously examined the heterogeneity in health outcomes associated with the intersection between mobile Internet use and health-seeking behaviors.

Methods

We used nationally representative data derived from the China Family Panel Studies. Given that individuals typically make the decision to use mobile Internet autonomously, an instrumental variable regression methodology was adopted to mitigate potential selection biases.

Results

Our findings revealed that mobile Internet use significantly promoted self-medication and adversely affected the use of primary care facilities among Chinese adults. Furthermore, our findings highlighted the heterogeneous effects of mobile Internet use across diverse health demographic groups.

Conclusion

These findings underscore the importance of strategic planning and utilizing mobile Internet resources to steer individuals toward more appropriate healthcare-seeking behaviors.

Assisted reproductive technology (ART) patient information-seeking behavior: a qualitative study

BACKGROUND

Approximately 13% of women in the United States of reproductive age seek infertility services. Assisted reproductive technology (ART), including in vitro fertilization, is used to help patients achieve pregnancy. Many people are not familiar with these treatments prior to becoming patients and possess knowledge gaps about care.

METHODS

This study employed qualitative methods to investigate how patients interact with information sources during care. Patients who underwent ART including embryo transfer between January 2017 and April 2022 at a large urban healthcare center were eligible. Semi-structured, in-depth interviews were conducted between August and October 2022. Fifteen females with an average age of 39 years participated. Reflexive thematic analysis was performed.

RESULTS

Two main themes emerged. Participants (1) utilized clinic-provided information and then turned to outside sources to fill knowledge gaps; (2) struggled to learn about costs, insurance, and mental health resources to support care. Participants preferred clinic-provided resources and then utilized academic sources, the internet, and social media when they had unfulfilled information needs. Knowledge gaps related to cost, insurance, and mental health support were reported.

CONCLUSION

ART clinics can consider providing more information about cost, insurance, and mental health support to patients.

TRIAL REGISTRATION

The Massachusetts General Hospital Institutional Review Board approved this study (#2022P000474) and informed consent was obtained from each participant.

Improving preliminary clinical diagnosis accuracy through knowledge filtering techniques in consultation dialogues

BACKGROUND AND OBJECTIVE

Symptom descriptions by ordinary people are often inaccurate or vague when seeking medical advice, which often leads to inaccurate preliminary clinical diagnoses. To address this issue, we propose a deep learning model named the knowledgeable diagnostic transformer (KDT) for the natural language processing (NLP)-based preliminary clinical diagnoses.

METHODS

The KDT extracts symptom-disease relation triples (h,r,t) from patient symptom descriptions by using a proposed bipartite medical knowledge graph (bMKG). To avoid too many relation triples causing the knowledge noise issue, we propose a knowledge inclusion-exclusion approach (KIA) to eliminate undesirable triples (a knowledge filtering layer). Next, we combine token embedding techniques with the transformer model to predict the diseases that patients may encounter.

RESULTS

To train the KDT, a medical diagnosis question-answering dataset (named MDQA dataset) containing large-scale, high-quality questions (patient syndrome description) and answering (diagnosis) corpora with 2.6M entries (1.07GB in size) in Mandarin was built. We also train the KDT with the National Institutes of Health (NIH) English dataset (MedQuAD). The KDT marks a transformative approach by achieving a remarkable accuracy of 99% for different evaluation metrics when compared with the baseline transformers used for the NLP-based preliminary clinical diagnoses approaches.

CONCLUSIONS

In essence, our study not only demonstrates the effectiveness of the KDT in enhancing diagnostic precision but also underscores its potential to revolutionize the field of preliminary clinical diagnoses. By harnessing the power of knowledge-based approaches and advanced NLP techniques, we have paved the way for more accurate and reliable diagnoses, ultimately benefiting both healthcare providers and patients. The KDT has the potential to significantly reduce misdiagnoses and improve patient outcomes, marking a pivotal advancement in the realm of medical diagnostics.

Critical review of self-diagnosis of mental health conditions using artificial intelligence

The advent of artificial intelligence (AI) has revolutionised various aspects of our lives, including mental health nursing. AI-driven tools and applications have provided a convenient and accessible means for individuals to assess their mental well-being within the confines of their homes. Nonetheless, the widespread trend of self-diagnosing mental health conditions through AI poses considerable risks. This review article examines the perils associated with relying on AI for self-diagnosis in mental health, highlighting the constraints and possible adverse outcomes that can arise from such practices. It delves into the ethical, psychological, and social implications, underscoring the vital role of mental health professionals, including psychologists, psychiatrists, and nursing specialists, in providing professional assistance and guidance. This article aims to highlight the importance of seeking professional assistance and guidance in addressing mental health concerns, especially in the era of AI-driven self-diagnosis.

The impact of eHealth on relationships and trust in primary care: a review of reviews

BACKGROUND

Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships.

METHODS

A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed.

RESULTS

A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively.

CONCLUSIONS

Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.

Pilot Testing of a Tool to Standardize the Assessment of the Quality of Health Information Generated by Artificial Intelligence-Based Models

Background Artificial intelligence (AI)-based conversational models, such as Chat Generative Pre-trained Transformer (ChatGPT), Microsoft Bing, and Google Bard, have emerged as valuable sources of health information for lay individuals. However, the accuracy of the information provided by these AI models remains a significant concern. This pilot study aimed to test a new tool with key themes for inclusion as follows: Completeness of content, Lack of false information in the content, Evidence supporting the content, Appropriateness of the content, and Relevance, referred to as "CLEAR", designed to assess the quality of health information delivered by AI-based models. Methods Tool development involved a literature review on health information quality, followed by the initial establishment of the CLEAR tool, which comprised five items that aimed to assess the following: completeness, lack of false information, evidence support, appropriateness, and relevance. Each item was scored on a five-point Likert scale from excellent to poor. Content validity was checked by expert review. Pilot testing involved 32 healthcare professionals using the CLEAR tool to assess content on eight different health topics deliberately designed with varying qualities. The internal consistency was checked with Cronbach's alpha (α). Feedback from the pilot test resulted in language modifications to improve the clarity of the items. The final CLEAR tool was used to assess the quality of health information generated by four distinct AI models on five health topics. The AI models were ChatGPT 3.5, ChatGPT 4, Microsoft Bing, and Google Bard, and the content generated was scored by two independent raters with Cohen's kappa (κ) for inter-rater agreement. Results The final five CLEAR items were: (1) Is the content sufficient?; (2) Is the content accurate?; (3) Is the content evidence-based?; (4) Is the content clear, concise, and easy to understand?; and (5) Is the content free from irrelevant information? Pilot testing on the eight health topics revealed acceptable internal consistency with a Cronbach's α range of 0.669-0.981. The use of the final CLEAR tool yielded the following average scores: Microsoft Bing (mean=24.4±0.42), ChatGPT-4 (mean=23.6±0.96), Google Bard (mean=21.2±1.79), and ChatGPT-3.5 (mean=20.6±5.20). The inter-rater agreement revealed the following Cohen κ values: for ChatGPT-3.5 (κ=0.875, P<.001), ChatGPT-4 (κ=0.780, P<.001), Microsoft Bing (κ=0.348, P=.037), and Google Bard (κ=.749, P<.001). Conclusions The CLEAR tool is a brief yet helpful tool that can aid in standardizing testing of the quality of health information generated by AI-based models. Future studies are recommended to validate the utility of the CLEAR tool in the quality assessment of AI-generated health-related content using a larger sample across various complex health topics.

The Management of Perinatal Borderline Personality Disorder

Borderline personality disorder (BPD) is highly prevalent in clinical perinatal mental health settings, although there are few systematic programmes to identify BPD at this time. Retrospective studies show compromised birth outcomes for women with this condition, and several authors have highlighted a significant range of problem outcomes for offspring identifiable from early infancy through the adult years, including the intergenerational transfer of mental health problems from mother to child. A literature review identifies the varying prevalence rates found in non-clinical and clinical settings and the paucity of published studies on the management of perinatal BPD, in particular focused both on the mother and mother-infant relationships. A case study is presented to show both the potential benefits of inpatient mother-baby unit protocols and of specialised longer-term group therapy. Many knowledge gaps can be identified for further clinical research that could potentially benefit families with perinatal BPD, including systematic identification of perinatal BPD and intensive programmes that not only could perhaps improve birth outcomes but also provide skills to mothers to help with their emotional regulation and potentially improve mother-infant relationships and longer-term offspring developmental pathways.

Supporting translation of research evidence into practice-the use of Normalisation Process Theory to assess and inform implementation within randomised controlled trials: a systematic review

BACKGROUND

The status of randomised controlled trials (RCTs) as the 'gold standard' for evaluating efficacy in healthcare interventions is increasingly debated among the research community, due to often insufficient consideration for implementation. Normalisation Process Theory (NPT), which focuses on the work required to embed processes into practice, offers a potentially useful framework for addressing these concerns. While the theory has been deployed in numerous RCTs to date, more work is needed to consolidate understanding of if, and how, NPT may aid implementation planning and processes within RCTs. Therefore, this review seeks to understand how NPT contributes to understanding the dynamics of implementation processes within RCTs. Specifically, this review will identify and characterise NPT operationalisation, benefits and reported challenges and limitations in RCTs.

METHODS

A qualitative systematic review with narrative synthesis of peer-reviewed journal articles from eight databases was conducted. Studies were eligible for inclusion if they reported sufficient detail on the use of NPT within RCTs in a healthcare domain. A pre-specified data extraction template was developed based on the research questions of this review. A narrative synthesis was performed to identify recurrent findings.

RESULTS

Searches identified 48 articles reporting 42 studies eligible for inclusion. Findings suggest that NPT is primarily operationalised prospectively during the data collection stage, with limited sub-construct utilisation overall. NPT is beneficial in understanding implementation processes by aiding the identification and analysis of key factors, such as understanding intervention fidelity in real-world settings. Nearly three-quarters of studies failed to report the challenges and limitations of utilising NPT, though coding difficulties and data falling outside the NPT framework are most common.

CONCLUSIONS

NPT appears to be a consistent and generalisable framework for explaining the dynamics of implementation processes within RCTs. However, operationalisation of the theory to its full extent is necessary to improve its use in practice, as it is currently deployed in varying capacities. Recommendations for future research include investigation of NPT alongside other frameworks, as well as earlier operationalisation and greater use of NPT sub-constructs.

TRIAL REGISTRATION

The protocol for this systematic review was accepted for public registration on PROSPERO (registration number: CRD42022345427) on 26 July 2022.

Analysis of the quality, accuracy, and readability of patient information on polycystic ovarian syndrome (PCOS) on the internet available in English: a cross-sectional study

BACKGROUND

Online information about PCOS lacks reliability for patients seeking information about the disease. Thus, we aimed to perform an updated analysis of the quality, accuracy, and readability of patient information on PCOS available online.

METHODS

We conducted a cross-sectional study using the top five Google Trends search terms in English associated with PCOS, including "symptoms," "treatment," "test," "pregnancy," and "causes." Five separate searches in Bing, Yahoo, and Google were performed to obtain the first 10 unique webpages for each term that was categorized as commercial, non-profit organization, scientific resources, or private foundation. We used the 16-item DISCERN with Likert-responses (minimum 1, maximum 5) where the total is 80 and lowest is 16, clarity with the 32-item EQIP, where responses of no = 0 and yes = 1 (minimum 0, maximum 32), and accuracy scores with 1 denoting poor and 5 completely accurate information; low scores of each corresponded to poorly reported information. We assessed readability with Flesch-Kincaid reading ease index, where higher scores correspond to reading ease, and lower grades correspond to easier readability with Flesch-Kincaid grade level, Gunning-Fog, Coleman-Liau index, automated readability index, New Dale-Chall Readability, and simple measure of gobbledygook. We additionally assessed word and sentence characteristics. We used Kruskal-Wallis test to compare scores according to webpage categories.

RESULTS

Out of 150 webpages, most were commercial (n = 85, 57%), followed by non-profit organizations (n = 44, 29%), scientific resources (n = 13, 9%) and private foundations (n = 6, 4%). Google webpages had higher median DISCERN score ([Md] = 47.0) than Bing ([Md] = 42.0) and Yahoo ([Md] = 43.0) webpages; P = 0.023. No difference in EQIP scores according to search engine was found (P = 0.524). Predominantly, webpages from private foundations had higher DISCERN and EQIP scores, although comparisons were not statistically significant (P = 0.456) and P = 0.653.). Accuracy and readability were similar across search engines and webpage categories (P = 0.915, range 5.0-5.0) and (P = 0.208, range 4.0-5.0).

CONCLUSIONS

Quality and clarity of the data were fair according to search engine and category. Accuracy of information was high, showing that the public may encounter accurate information about PCOS. However, the readability of the information was high, reflecting a need for more readable resources about PCOS.

A Clinical Preventive Strategy Based on a Digital Tool to Improve Access to Endocrine Disruptors Exposure Prevention: The MEDPREVED Study

Introduction: The digitalized PREVED (PREgnancy, PreVention, Endocrine Disruptor) questionnaire was used in the clinical practices of health professionals (HP) who adhered to the MEDPREVED strategy. The objectives were to assess the strategy and to determine if it could improve access to endocrine disruptor (ED) exposure prevention. Methods: After having filled in the digital questionnaire in HP waiting rooms, patients were invited to talk about ED exposure during the consultation. HPs were previously trained in ED and had received a prevention kit for their patients. After the seven-month implementation phase, the evaluation phase consisted of five mixed assessments: interviews with: (i) patients who were young children's parents; (ii) patients in the general population; (iii) paediatricians; (iv) midwives; and a quantitative study on GPs. Assessment concerned feasibility, accessibility, and usefulness of the strategy; we then used the Levesque model to evaluate how it could improve access to ED exposure prevention. Results: The study included 69 participants. The strategy appeared feasible for the filling-out step due to digital and environment access. However, it depended on patient and HP profiles. The strategy seemed useful insofar as it facilitated reflexive investment, an intention to healthy behaviour and, rather rarely, talk about ED exposure. The beginning of this discussion depended on time, prioritizing of the topic and HP profile. The strategy has confirmed the Levesque model's limiting factors and levers to access ED prevention. Conclusions: The MEDPREVED strategy is feasible, accessible, and useful in clinical prevention practice. Further study is needed to measure the impact on knowledge, risk perception and behavior of beneficiaries of the MEDPREVED strategy in the medium and long term.

Mobile Sensing in the COVID-19 Era: A Review

Background

During the COVID-19 pandemic, mobile sensing and data analytics techniques have demonstrated their capabilities in monitoring the trajectories of the pandemic, by collecting behavioral, physiological, and mobility data on individual, neighborhood, city, and national scales. Notably, mobile sensing has become a promising way to detect individuals' infectious status, track the change in long-term health, trace the epidemics in communities, and monitor the evolution of viruses and subspecies.

Methods

We followed the PRISMA practice and reviewed 60 eligible papers on mobile sensing for monitoring COVID-19. We proposed a taxonomy system to summarize literature by the time duration and population scale under mobile sensing studies.

Results

We found that existing literature can be naturally grouped in four clusters, including remote detection, long-term tracking, contact tracing, and epidemiological study. We summarized each group and analyzed representative works with regard to the system design, health outcomes, and limitations on techniques and societal factors. We further discussed the implications and future directions of mobile sensing in communicable diseases from the perspectives of technology and applications.

Conclusion

Mobile sensing techniques are effective, efficient, and flexible to surveil COVID-19 in scales of time and populations. In the post-COVID era, technical and societal issues in mobile sensing are expected to be addressed to improve healthcare and social outcomes.

UK healthcare services for people with fibromyalgia: results from two web-based national surveys (the PACFiND study)

Background

The UK’s “Getting It Right First Time” programme recommends that management of people with fibromyalgia should centre on primary care. However, it remains unclear as to how best to organise health systems to deliver services to optimise patient outcomes.

Aim

To profile UK healthcare services for people with fibromyalgia: provision of National Health Services (NHS) and use of non-NHS services by people with fibromyalgia.

Methods

Two online open surveys (A and B) incorporating questions about diagnosis, treatment and management of fibromyalgia and gaps in healthcare services were conducted between 11th September 2019 and 3rd February 2020. These were targeted to NHS healthcare professionals consulting with people with fibromyalgia (Survey A) and people ≥16 years diagnosed with fibromyalgia using non-NHS services to manage their condition (Survey B). Descriptive statistics were used to report quantitative data. Thematic analysis was undertaken for qualitative data.

Results

Survey A received 1701 responses from NHS healthcare professionals across the UK. Survey B received 549 responses from people with fibromyalgia. The results show that NHS services for people with fibromyalgia are highly disparate, with few professionals reporting care pathways in their localities. Diagnosing fibromyalgia is variable among NHS healthcare professionals and education and pharmacotherapy are mainstays of NHS treatment and management. The greatest perceived unmet need in healthcare for people with fibromyalgia is a lack of available services. From the pooled qualitative data, three themes were developed: ‘a troublesome label’, ‘a heavy burden’ and ‘a low priority’. Through the concept of candidacy, these themes provide insight into limited access to healthcare for people with fibromyalgia in the UK.

Conclusion

This study highlights problems across the NHS in service provision and access for people with fibromyalgia, including several issues less commonly discussed; potential bias towards people with self-diagnosed fibromyalgia, challenges facing general practitioners seeking involvement of secondary care services for people with fibromyalgia, and a lack of mental health and multidisciplinary holistic services to support those affected. The need for new models of primary and community care that offer timely diagnosis, interventions to support self-management with access to specialist services if needed, is paramount.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08324-4.

Effect of Intelligent Medical Management Platform Combined with Perioperative Detailed Nursing on Cognitive Ability, Postoperative Complications, and Quality of Life of Patients Undergoing Hysterectomy

Objective. To analyze the effect of an intelligent medical management platform combined with perioperative detailed nursing on cognitive ability, postoperative complications, and quality of life (QOL) of patients undergoing hysterectomy. Methods. The clinical data of 76 patients undergoing hysterectomy in our hospital from December 2019 to December 2021 were selected for the retrospective analysis, and the patients were divided into the experimental group (EG, $n=38$ , intelligent medical management platform+perioperative detailed nursing) and the routine group (RG, $n=38$ , routine nursing) according to their admission order, and the cognition of disease and QOL after intervention of patients in the two groups were evaluated by the self-proposed questionnaire on cognition of disease of our hospital and the MOS 36-item short-form health survey (SF-36). Results. After intervention, the scores on cognitive ability, various nursing items, and QOL were significantly higher in EG than in RG ( $P<0.001$ ), and during the study, the total incidence rate of complications was significantly lower in EG than in RG ( $P<0.05$ ). Conclusion. Combining an intelligent medical management platform with perioperative detailed nursing is a reliable method to improve QOL and reduce postoperative complications for patients undergoing hysterectomy. Further research will be conducive to providing a reliable perioperative intervention scheme for such patients.

Online health information-seeking behaviour of patients attending a primary care clinic in Malaysia: a cross-sectional study

BACKGROUND

The internet has become a common source of health information; however, little is known about online health information-seeking behaviour (HISB) among patients in low- and middle-income countries (LMICs).

OBJECTIVES

This study aimed to determine the prevalence of online health information-seeking and its associated factors among patients in primary care in Malaysia. We also examined the reasons for, and the sources of, online health information-seeking, patients' level of trust in the information found and what the information was used for.

METHODS

A cross-sectional study using a self-administered questionnaire was conducted on patients who attended a primary care clinic. The questionnaire included the use of the internet to seek health information, sources and types of health information, eHealth literacy, patients' trust in online information, and how patients appraise and use online health information.

RESULTS

Out of 381 patients in this study, 54.7% (n = 208) used the internet to search for health information. Patients mainly sought information via Google (96.2%) and the most common websites that they visited were Wikipedia (45.2%) and MyHEALTH (37.5%). Higher levels of education, longer duration of internet use, and higher eHealth literacy were significantly associated with online HISB. Patients' trust in websites (45.6%) and social media (20.7%) was low when compared to trust in healthcare professionals (87.9%). Only 12.9% (n = 22) of patients had discussed online health information with their doctors.

CONCLUSION

Online HISB was common among primary care patients; however, their eHealth literacy was low, with suboptimal appraisal skills to evaluate the accuracy of online health information.

Digital health for quality healthcare: A systematic mapping of review studies

Objective

To systematically catalogue review studies on digital health to establish extent of evidence on quality healthcare and illuminate gaps for new understanding, perspectives and insights for evidence-informed policies and practices.

Methods

We systematically searched PubMed database using sensitive search strings. Two reviewers independently conducted two-phase selection via title and abstract, followed by full-text appraisal. Consensuses were derived for any discrepancies. A standardized data extraction tool was used for reliable data mining.

Results

A total of 54 reviews from year 2014 to 2021 were included with notable increase in trend of publications. Systematic reviews constituted the majority (61.1%, (37.0% with meta-analyses)) followed by scoping reviews (38.9%). Domains of quality being reviewed include effectiveness (75.9%), accessibility (33.3%), patient safety (31.5%), efficiency (25.9%), patient-centred care (20.4%) and equity (16.7%). Mobile apps and computer-based were the commonest (79.6%) modalities. Strategies for effective intervention via digital health included engineering improved health behaviour (50.0%), better clinical assessment (35.1%), treatment compliance (33.3%) and enhanced coordination of care (24.1%). Psychiatry was the discipline with the most topics being reviewed for digital health (20.3%).

Conclusion

Digital health reviews reported findings that were skewed towards improving the effectiveness of intervention via mHealth applications, and predominantly related to mental health and behavioural therapies. There were considerable gaps on review of evidence on digital health for cost efficiency, equitable healthcare and patient-centred care. Future empirical and review studies may investigate the association between fields of practice and tendency to adopt and research the use of digital health to improve care.

'I think there is nothing . . . that is really comprehensive': healthcare professionals' views on recommending online resources for pain self-management

Objectives

To explore healthcare professionals' views on, and attitudes, towards recommending online resources for persistent pain self-management.

Methods

This study was the qualitative phase of a two-phase mixed method study. Thirty-one New Zealand health professionals involved in the management of persistent pain were interviewed via focus groups and individual interviews. Data were analysed using the general inductive approach.

Results

The major themes were as follows: (1) risks and limits of online information outweigh benefits, (2) a blended model, of online resources with healthcare professional support, could work, (3) only trustworthy resources can be recommended, (4) need for personalisation and (5) perceived barriers to adoption.

Conclusion

Online resources were perceived as a useful adjunct to support pain self-management; however, due to potential risks of misinterpretation and misinformation, healthcare professionals proposed a 'blended model' where curated online resources introduced during face-to-face consultations could be used to support self-management. Participants needed 'trustworthy online resources' that provide evidence-based, updated information that is personalised to clients' health literacy and cultural beliefs.

Practice implications

Training for healthcare professionals on critical appraisal of online resources or curation of evidence-based online resources could increase recommendation of online resources to support pain self-management as an adjunct to in-person care.

Understanding the use of heart failure online health forums: a qualitative study

AIMS

Heart failure is a major public health challenge and is described as an epidemic. Many people resort to the internet as a source of health information and online health forums have become an increasingly common way to obtain information and support regarding health-related issues. This study aims to explore what information people concerned about heart failure seek from online health forums, and how this shapes decision-making, trust, and interactions with healthcare professionals.

METHODS AND RESULTS

Widely available internet search engines (Google, Yahoo, and Bing) were used to identify online health forums, accessed by people seeking information on heart failure. Comments posted between 2016 and 2019 were screened, downloaded, and analysed thematically. Normalization Process Theory provided the underlying conceptual lens to inform analysis. Ten online health forums were identified, and 204 individual posts analysed. Three themes were identified [(information and support needs; online diagnosis; and relationship with healthcare professionals (HCPs)]. The most common purpose for using online health forums was to plug information/knowledge gaps surrounding diagnosis or treatments (e.g. discussion of results, medication/health insurance queries). They were used as a tool to aid decision-making regarding, (i) whether to seek further medical attention and (ii) lifestyle choices, medications, and other advice surrounding concerns. Negative experiences with HCPs were discussed, and sometimes online health forums appeared to promote distrust with HCPs.

CONCLUSION

Online health forums offer a supportive platform and help fill key informational gaps. However, online forums may amplify distrust with HCPs.

How access to online health information affects the dental hygiene client experience

OBJECTIVE

Due to the widespread availability of online information, oral care providers are no longer the main source of oral health information for clients. This shift in the balance of knowledge has the potential to alter clients' experiences and relationships with their oral care providers, including dental hygienists. This review explores how access to online health information has influenced clients' experiences with their dental hygienists.

METHOD

A narrative literature review of quantitative, qualitative, and mixed,method studies concerning clients' experiences with online health information and how it has influenced the client-health care professional relationship was completed. The electronic databases searched were Google Scholar^TM, PubMed, and CINAHL. Twenty-three studies published between 2005 and 2020 were included.

RESULTS AND DISCUSSION

The majority of clients used the internet to access health information to be better informed about health issues. Both clients and health care providers had concerns about the legitimacy and accuracy of various online information sources. Clients faced various communication facilitators and barriers when discussing this information with their health care provider. A positive response by the health care provider led to an improved client-clinician relationship, whereas a negative response led to distrust among all parties. Clients would be open to e-health literacy training by their dental hygienists.

CONCLUSION

Clients' access to online health information can either improve or worsen their experiences and relationships with their dental hygienists, depending on the response by the dental hygienist when these topics are broached. Dental hygienists should consider taking time to provide e-health literacy training to clients during consultations.

An analysis of the diagnostic accuracy and peer-to-peer health information provided on online health forums for heart failure

AIMS

To examine the accuracy of diagnostic responses and types of information provided on online health forums.

DESIGN

Qualitative descriptive study.

METHODS

This paper reports the findings of a thematic analysis of peer responses to posts included on heart failure online health forums, to understand the quality and types of information provided. Responses posted between March 2016 and March 2019 were screened, collected and analysed thematically using Braun & Clarke. Themes were conceptually underpinned by Normalization Process Theory. Responses were assessed for quality against the NICE and SIGN guidelines to determine whether they were evidence based or not.

RESULTS

The total number of responses collected for analysis was 639. Five main themes were identified: diagnostic, experiential, informational, peer relations and relationships with healthcare professionals. Out of 298 diagnostic responses, 5% were guideline evidence-based and 6% had information that were partly evidence-based. Non-evidence based and potentially dangerous responses were 10%. Experiential responses were 10%; 23% included advice that was not supported with any clinical evidence; and 46% signposted users to other online references/healthcare professionals.

CONCLUSION

Online health communication largely focuses on provision of experiential responses to assist those in need of pre- or post-diagnosis advice and support. However, there is evidence of inaccurate information provision which suggests the use of a moderator would be beneficial.

IMPACT

This study suggests heart failure online health forums are a source of support, however, there are potential risks. Increasing nurses and other health care professional's awareness of online health forums will be important. Additional training is needed to help them learn more about patient's use of online health forums, to gain a better understanding about the types of information sought, and how best to address such knowledge deficits. Healthcare systems must ensure sufficient time and resources are available to meet information needs for people with heart failure.