Can cognitive biases during consumer health information searches be reduced to improve decision making?

Representativeness and face-ism: Gender bias in image search

Implicit and explicit gender biases in media representations of individuals have long existed. Women are less likely to be represented in gender-neutral media content (representation bias), and their face-to-body ratio in images is often lower (face-ism bias). In this article, we look at representativeness and face-ism in search engine image results. We systematically queried four search engines (Google, Bing, Baidu, Yandex) from three locations, using two browsers and in two waves, with gender-neutral (person, intelligent person) and gendered (woman, intelligent woman, man, intelligent man) terminology, accessing the top 100 image results. We employed automatic identification for the individual's gender expression (female/male) and the calculation of the face-to-body ratio of individuals depicted. We find that, as in other forms of media, search engine images perpetuate biases to the detriment of women, confirming the existence of the representation and face-ism biases. In-depth algorithmic debiasing with a specific focus on gender bias is overdue.

Family informatics

While families have a central role in shaping individual choices and behaviors, healthcare largely focuses on treating individuals or supporting self-care. However, a family is also a health unit. We argue that family informatics is a necessary evolution in scope of health informatics. To deal with the needs of individuals, we must ensure technologies account for the role of their families and may require new classes of digital service. Social networks can help conceptualize the structure, composition, and behavior of families. A family network can be seen as a multiagent system with distributed cognition. Digital tools can address family needs in (1) sensing and monitoring; (2) communicating and sharing; (3) deciding and acting; and (4) treating and preventing illness. Family informatics is inherently multidisciplinary and has the potential to address unresolved chronic health challenges such as obesity, mental health, and substance abuse, support acute health challenges, and to improve the capacity of individuals to manage their own health needs.

Can the Standard Configuration of a Cardiac Monitor Lead to Medical Errors under a Stress Induction?

The essential factor that enables medical patient monitoring is the vital signs monitor, whereas the key in communication with the monitor is the user interface. The way the data display on the monitors is standard, and it is often not changed; however, vital signs monitors are now configurable. Not all the data have to be displayed concurrently; not all data are necessary at a given moment. There arises a question: is the standard monitor configuration sufficient, or can it lead to mistakes related to delays in perceiving parameter changes? Some researchers argue that mistakes in life-saving activities is not mainly due to medical mistakes but due to poorly designed patient life monitor interfaces, among other reasons. In addition, it should be emphasized that the activity that saves the patient’s life is accompanied by stress, which is often caused by the chaos occurring in the hospital emergency department. This raises the following question: is the standard user interface, which they are used to, still effective under stress conditions? Therefore, our primary consideration is the measure of reaction speed of medical staff, which means the perception of the changes of vital signs on the patient’s monitor, for stress and stressless situations. The paper attempts to test the thesis of the importance of the medical interface and its relation to medical mistakes, extending it with knowledge about the difference in speed of making decisions by the medical staff with regard to the stress stimulus.

Can "Googling" correct misbelief? Cognitive and affective consequences of online search

With increasing concern over online misinformation in perspective, this study experimentally examined the cognitive as well as the affective consequences of online search. Results of the two experiments using widely shared, prejudiced misinformation about an ethnic minority in Japan indicated that (a) online search reduces on average the likelihood of believing the misinformation, (b) the magnitude of the effect is larger among those who are predisposed to believe the misinformation, (c) cognitive correction is observed whether searchers are motivated to achieve a directional goal or an accuracy goal, and (d) online search deteriorates affective feeling toward the target groups of the misinformation. Theoretical implications are discussed in relation to the robustness of confirmation bias in online search and the “belief echo” in which exposure to negative misinformation continues to shape attitudes even after the misinformation has been effectively discredited.

A systematic integrative review of cognitive biases in consumer health information seeking: emerging perspective of behavioral information research

Purpose

With the growing interest in behavioral health and medical decision-making, this systematic integrative review aims to understand research on cognitive biases in the context of consumer health information seeking and where future research opportunities may reside.

Design/methodology/approach

Following a systematic review protocol, 40 empirical research articles, out of 1,127 journal research papers from 12 academic databases, from 1995 to 2019, are included for review.

Findings

The study of cognitive biases in consumer health information seeking is a nascent and fast-growing phenomenon, with variety in publication venues and research methods. Among the 16 biases investigated, optimistic bias and confirmation bias have attracted most attention (46.9%). Researchers are most interested in specific disease/illness (35%) and the health factors of consumer products (17.5%). For theoretical presence, about one-third of the reviewed articles have cited behavioral economist Daniel Kahneman, although most of the references are the early works of Kahneman.

Research limitations/implications

As an emerging research area, there exists plenty of cognitive biases to be investigated in the context of health information seeking. In the meantime, the adoption of more recent theoretical insights such as nudge for debiasing may enrich this research area. Health communication scientists may find incorporating the behavioral decision research framework enriches the disciplinary inquiry of health information seeking, while information scientists could use it to commence the cognitive turn of information science evolution.

Originality/value

Through evidence-based understanding, this review shows the potential research directions that health communication scientists and information scientists could contribute to optimize health decisions through the adoption of behavioral decision research framework.

Debiasing Health-Related Judgments and Decision Making: A Systematic Review

BACKGROUND

Being confronted with uncertainty in the context of health-related judgments and decision making can give rise to the occurrence of systematic biases. These biases may detrimentally affect lay persons and health experts alike. Debiasing aims at mitigating these negative effects by eliminating or reducing the biases. However, little is known about its effectiveness. This study seeks to systematically review the research on health-related debiasing to identify new opportunities and challenges for successful debiasing strategies.

METHODS

A systematic search resulted in 2748 abstracts eligible for screening. Sixty-eight articles reporting 87 relevant studies met the predefined inclusion criteria and were categorized and analyzed with regard to content and quality. All steps were undertaken independently by 2 reviewers, and inconsistencies were resolved through discussion.

RESULTS

The majority of debiasing interventions ( n = 60) was at least partially successful. Optimistic biases ( n = 25), framing effects ( n = 14), and base rate neglects ( n = 10) were the main targets of debiasing efforts. Cognitive strategies ( n = 36) such as "consider-the-opposite" and technological interventions ( n = 33) such as visual aids were mainly tested. Thirteen studies aimed at debiasing health care professionals' judgments, while 74 interventions addressed the general population. Studies' methodological quality ranged from 26.2% to 92.9%, with an average rating of 68.7%.

DISCUSSION

In the past, the usefulness of debiasing was often debated. Yet most of the interventions reviewed here are found to be effective, pointing to the utility of debiasing in the health context. In particular, technological strategies offer a novel opportunity to pursue large-scale debiasing outside the laboratory. The need to strengthen the transfer of debiasing interventions to real-life settings and a lack of conceptual rigor are identified as the main challenges requiring further research.

HealthRecSys: A semantic content-based recommender system to complement health videos

BACKGROUND

The Internet, and its popularity, continues to grow at an unprecedented pace. Watching videos online is very popular; it is estimated that 500 h of video are uploaded onto YouTube, a video-sharing service, every minute and that, by 2019, video formats will comprise more than 80% of Internet traffic. Health-related videos are very popular on YouTube, but their quality is always a matter of concern. One approach to enhancing the quality of online videos is to provide additional educational health content, such as websites, to support health consumers. This study investigates the feasibility of building a content-based recommender system that links health consumers to reputable health educational websites from MedlinePlus for a given health video from YouTube.

METHODS

The dataset for this study includes a collection of health-related videos and their available metadata. Semantic technologies (such as SNOMED-CT and Bio-ontology) were used to recommend health websites from MedlinePlus. A total of 26 healths professionals participated in evaluating 253 recommended links for a total of 53 videos about general health, hypertension, or diabetes. The relevance of the recommended health websites from MedlinePlus to the videos was measured using information retrieval metrics such as the normalized discounted cumulative gain and precision at K.

RESULTS

The majority of websites recommended by our system for health videos were relevant, based on ratings by health professionals. The normalized discounted cumulative gain was between 46% and 90% for the different topics.

CONCLUSIONS

Our study demonstrates the feasibility of using a semantic content-based recommender system to enrich YouTube health videos. Evaluation with end-users, in addition to healthcare professionals, will be required to identify the acceptance of these recommendations in a nonsimulated information-seeking context.

The Unintended Consequences of Health Information Technology Revisited

INTRODUCTION

The introduction of health information technology into clinical settings is associated with unintended negative consequences, some with the potential to lead to error and patient harm. As adoption rates soar, the impact of these hazards will increase.

OBJECTIVE

Over the last decade, unintended consequences have received great attention in the medical informatics literature, and this paper seeks to identify the major themes that have emerged.

RESULTS

Rich typologies of the causes of unintended consequences have been developed, along with a number of explanatory frameworks based on socio-technical systems theory. We however still have only limited data on the frequency and impact of these events, as most studies rely on data sets from incident reporting or patient chart reviews, rather than undertaking detailed observational studies. Such data are increasingly needed as more organizations implement health information technologies. When outcome studies have been done in different organizations, they reveal different outcomes for identical systems. From a theoretical perspective, recent advances in the emerging discipline of implementation science have much to offer in explaining the origin, and variability, of unintended consequences.

CONCLUSION

The dynamic nature of health care service organizations, and the rapid development and adoption of health information technologies means that unintended consequences are unlikely to disappear, and we therefore must commit to developing robust systems to detect and manage them.

Does it matter whether physicians' recommendations are given early or late in the decision-making process? An experimental study among patients with schizophrenia

OBJECTIVES

Physicians' recommendations are seen as an essential component in many models of medical decision-making, including shared decision-making. It is, however, unclear at what time in the decision-making process the recommendation is best given, not to adversely influence patient preferences. Within the present study we wanted to evaluate at what time in the decision-making process a doctor's recommendation is best given, not to adversely influence patient preferences.

DESIGN

We performed an experimental study involving hypothetical decisions vignettes and compared the influence of 3 conditions (no advice, early advice, late advice) on patients' decision-making.

SETTING

N=21 psychiatric hospitals in Germany.

PARTICIPANTS

N=208 inpatients suffering from schizophrenia.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main outcome was the number of patients choosing the option in each experimental condition that had been less preferable to most patients during pretests. Additional outcome measures were patient satisfaction and reactance.

RESULTS

Patients in the 'late advice' condition more often (n=49) accepted an advice that was against their preferences compared with the other conditions (n=36 for 'early advice', p=0.024).

CONCLUSIONS

Although giving advice is an important part of every doctor's daily practice and is seen as an essential element of shared decision-making, hitherto there has been little empirical evidence relating to the influence of physicians' advice on patients' decision-making behaviour. With our study we could show that the point in time an advice is given by a physician does have an influence on patients' decisional behaviour even if the mechanism of this effect is not yet understood.

Manipulating Google's Knowledge Graph Box to Counter Biased Information Processing During an Online Search on Vaccination: Application of a Technological Debiasing Strategy

Background

One of people’s major motives for going online is the search for health-related information. Most consumers start their search with a general search engine but are unaware of the fact that its sorting and ranking criteria do not mirror information quality. This misconception can lead to distorted search outcomes, especially when the information processing is characterized by heuristic principles and resulting cognitive biases instead of a systematic elaboration. As vaccination opponents are vocal on the Web, the chance of encountering their non‒evidence-based views on immunization is high. Therefore, biased information processing in this context can cause subsequent impaired judgment and decision making. A technological debiasing strategy could counter this by changing people’s search environment.

Objective

This study aims at testing a technological debiasing strategy to reduce the negative effects of biased information processing when using a general search engine on people’s vaccination-related knowledge and attitudes. This strategy is to manipulate the content of Google’s knowledge graph box, which is integrated in the search interface and provides basic information about the search topic.

Methods

A full 3x2 factorial, posttest-only design was employed with availability of basic factual information (comprehensible vs hardly comprehensible vs not present) as the first factor and a warning message as the second factor of experimental manipulation. Outcome variables were the evaluation of the knowledge graph box, vaccination-related knowledge, as well as beliefs and attitudes toward vaccination, as represented by three latent variables emerged from an exploratory factor analysis.

Results

Two-way analysis of variance revealed a significant main effect of availability of basic information in the knowledge graph box on participants’ vaccination knowledge scores (F_2,273=4.86, P=.01), skepticism/fear of vaccination side effects (F_2,273=3.5, P=.03), and perceived information quality (F_2,273=3.73, P=.02). More specifically, respondents receiving comprehensible information appeared to be more knowledgeable, less skeptical of vaccination, and more critical of information quality compared to participants exposed to hardly comprehensible information. Although, there was no significant interaction effect between the availability of information and the presence of the warning, there was a dominant pattern in which the presence of the warning appeared to have a positive influence on the group receiving comprehensible information while the opposite was true for the groups exposed to hardly comprehensible information and no information at all. Participants evaluated the knowledge graph box as moderately to highly useful, with no significant differences among the experimental groups.

Conclusion

Overall, the results suggest that comprehensible information in the knowledge graph box positively affects participants’ vaccination-related knowledge and attitudes. A small change in the content retrieval procedure currently used by Google could already make a valuable difference in the pursuit of an unbiased online information search. Further research is needed to gain insights into the knowledge graph box’s entire potential.

The influence of positive hypothesis testing on youths’ online health-related information seeking

Purpose

– The aim of this paper is to investigate whether/how youths’ pre-existing beliefs regarding health-related topics influence their online searching behaviors, such as their selection of keywords and search results, their credibility assessments and the conclusions they draw and the uses they make (or do not make) of the information they find. More specifically, we sought to determine whether positive hypothesis testing occurs when youth search for health information online and to ascertain the potential impacts this phenomenon can have on their search behaviors, their ability to accurately answer health-related questions and their confidence in their answers.

Design/methodology/approach

– An exploratory field experiment was conducted with participants in an after-school program (“HackHealth”), which aims to improve the health literacy skills and health-related self-efficacy of middle-school students from socio-economically disadvantaged backgrounds.

Findings

– Evidence of positive hypothesis testing among the participants was found and important impacts on their search outcomes were observed.

Practical implications

– The paper was concluded with suggestions for improving digital literacy instruction for youth so as to counteract the potentially negative influences of positive hypothesis testing.

Originality/value

– This study extends existing research about positive hypothesis testing to investigate the existence and impact of this phenomenon within the context of tweens (ages 11-14) searching for health information online.

How online crowds influence the way individual consumers answer health questions: an online prospective study

OBJECTIVE

To investigate whether strength of social feedback, i.e. other people who concur (or do not concur) with one's own answer to a question, influences the way one answers health questions.

METHODS

Online prospective study. Two hundred and twenty-seven undergraduate students were recruited to use an online search engine to answer six health questions. Subjects recorded their pre- and post-search answers to each question and their level of confidence in these answers. After answering each question post-search, subjects were presented with a summary of post-search answers provided by previous subjects and were asked to answer the question again.

RESULTS

There was a statistically significant relationship between the absolute number of others with a different answer (the crowd's opinion volume) and the likelihood of an individual changing an answer (P<0.001). For most questions, no subjects changed their answer until the first 10-35 subjects completed the study. Subjects' likelihood of changing answer increased as the percentage of others with a different answer (the crowd's opinion density) increased (P=0.047). Overall, 98.3% of subjects did not change their answer when it concurred with the majority (i.e. >50%) of subjects, and that 25.7% of subjects changed their answer to the majority response when it did not concur with the majority. When subjects had a post-search answer that did not concur with the majority, they were 24% more likely to change answer than those with answers that concurred (P<0.001).

CONCLUSION

This study provides empirical evidence that crowd influence, in the form of online social feedback, affects the way consumers answer health questions.

Supporting effective health and biomedical information retrieval and navigation: a novel facet view interface evaluation

There is a need to provide a more effective user interface to facilitate non-domain experts' health information seeking in authoritative online databases such as MEDLINE. We developed a new topic cluster based information navigation system called SimMed. Instead of offering a list of documents, SimMed presents users with a list of ranked clusters. Topically similar documents are grouped together to provide users with a better overview of the search results and to support exploration of similar literature within a cluster. We conducted an empirical user study to compare SimMed to a traditional document list based search interface. A total of 42 study participants were recruited to use both interfaces for health information exploration search tasks. The results showed that SimMed is more effective in terms of users' perceived topic knowledge changes and their engagement in user-system interactions. We also developed a new metric to assess users' efforts to find relevant citations. On average, users need significantly fewer clicks to find relevant information in SimMed than in the baseline system. Comments from study participants indicated that SimMed is more helpful in finding similar citations, providing related medical terms, and presenting better organized search results, particularly when the initial search is unsatisfactory. Findings from the study shed light on future health and biomedical information retrieval system and interface designs.