Consumer Health Informatics: Past, Present, and Future of a Rapidly Evolving Domain

Online health information searching and health literacy among middle-aged and older adults: A cross-sectional study

Given the rapid increase in health information available, health literacy is now more important than ever when searching for health information online. Furthermore, health literacy and online health information searching are reported to be associated with support from others. In this study, we examined the associations of health literacy and social support with online health information searching among individuals in their 50s and 60s. Between March and May 2022, an anonymous self-administered questionnaire was administered among 750 middle-aged and older adults (age 50-69) living in northern Japan. The questionnaire items included personal characteristics, frequency of online health information searching, health literacy domains, and social support. A total of 237 respondents answered all the items (response rate: 31.6%). Multiple logistic regression analysis revealed that communicative health literacy was significantly associated with searching for information about illnesses and health promotion, while critical health literacy was significantly associated with searching for information about medical institutions. Controlling for personal characteristics, health literacy, was associated with online health information searching, suggesting that improving health literacy is important in a digital and information society.

From illness management to quality of life: rethinking consumer health informatics opportunities for progressive, potentially fatal illnesses

OBJECTIVES

Investigate how people with chronic obstructive pulmonary disease (COPD)-an example of a progressive, potentially fatal illness-are using digital technologies (DTs) to address illness experiences, outcomes and social connectedness.

MATERIALS AND METHODS

A transformative mixed methods study was conducted in Canada with people with COPD (n = 77) or with a progressive lung condition (n = 6). Stage-1 interviews (n = 7) informed the stage-2 survey. Survey responses (n = 80) facilitated the identification of participants for stage-3 interviews (n = 13). The interviews were thematically analyzed. Descriptive statistics were calculated for the survey. The integrative mixed method analysis involved mixing between and across the stages.

RESULTS

Most COPD participants (87.0%) used DTs. However, few participants frequently used DTs to self-manage COPD. People used DTs to seek online information about COPD symptoms and treatments, but lacked tailored information about illness progression. Few expressed interest in using DTs for self- monitoring and tracking. The regular use of DTs for intergenerational connections may facilitate leaving a legacy and passing on traditions and memories. Use of DTs for leisure activities provided opportunities for connecting socially and for respite, reminiscing, distraction and spontaneity.

DISCUSSION AND CONCLUSION

We advocate reconceptualizing consumer health technologies to prioritize quality of life for people with a progressive, potentially fatal illness. "Quality of life informatics" should focus on reducing stigma regarding illness and disability and taboo towards death, improving access to palliative care resources and encouraging experiences to support social, emotional and mental health. For DTs to support people with fatal, progressive illnesses, we must expand informatics strategies to quality of life.

Artificial Intelligence-Based Consumer Health Informatics Application: Scoping Review

BACKGROUND

There is no doubt that the recent surge in artificial intelligence (AI) research will change the trajectory of next-generation health care, making it more approachable and accessible to patients. Therefore, it is critical to research patient perceptions and outcomes because this trend will allow patients to be the primary consumers of health technology and decision makers for their own health.

OBJECTIVE

This study aimed to review and analyze papers on AI-based consumer health informatics (CHI) for successful future patient-centered care.

METHODS

We searched for all peer-reviewed papers in PubMed published in English before July 2022. Research on an AI-based CHI tool or system that reports patient outcomes or perceptions was identified for the scoping review.

RESULTS

We identified 20 papers that met our inclusion criteria. The eligible studies were summarized and discussed with respect to the role of the AI-based CHI system, patient outcomes, and patient perceptions. The AI-based CHI systems identified included systems in mobile health (13/20, 65%), robotics (5/20, 25%), and telemedicine (2/20, 10%). All the systems aimed to provide patients with personalized health care. Patient outcomes and perceptions across various clinical disciplines were discussed, demonstrating the potential of an AI-based CHI system to benefit patients.

CONCLUSIONS

This scoping review showed the trend in AI-based CHI systems and their impact on patient outcomes as well as patients' perceptions of these systems. Future studies should also explore how clinicians and health care professionals perceive these consumer-based systems and integrate them into the overall workflow.

Integrated Personal Health Record in Indonesia: Design Science Research Study

BACKGROUND

Personal health records (PHRs) are consumer-centric tools designed to facilitate the tracking, management, and sharing of personal health information. PHR research has mainly been conducted in high-income countries rather than in low- and middle-income countries. Moreover, previous studies that proposed PHR design in low- and middle-income countries did not describe integration with other systems, or there was no stakeholder involvement in exploring PHR requirements.

OBJECTIVE

This study developed an integrated PHR architecture and prototype in Indonesia using design science research. We conducted the research in Indonesia, a low- to middle-income country with the largest population in Southeast Asia and a tiered health system.

METHODS

This study followed the design science research guidelines. The requirements were identified through interviews with 37 respondents from health organizations and a questionnaire with 1012 patients. Afterward, the proposed architecture and prototype were evaluated via interviews with 6 IT or eHealth experts.

RESULTS

The architecture design refers to The Open Group Architecture Framework version 9.2 and comprises 5 components: architecture vision, business architecture, application architecture, data architecture, and technology architecture. We developed a high-fidelity prototype for patients and physicians. In the evaluation, improvements were made to add the stakeholders and the required functionality to the PHR and add the necessary information to the functions that were developed in the prototype.

CONCLUSIONS

We used design science to illustrate PHR integration in Indonesia, which involves related stakeholders in requirement gathering and evaluation. We developed architecture and application prototypes based on health systems in Indonesia, which comprise routine health services, including disease treatment and health examinations, as well as promotive and preventive health efforts.

GoTO: A Process-Navigation Tool for Telehealth and -Care Solutions, Designed to Ensure an Efficient Trajectory from Goal Setting to Outcome Evaluation

Objectives: The digital transformation of the healthcare sector involves the procurement and implementation of new health technologies, which will likely be a challenge to healthcare providers who are not part of large organizations. In response to the needs of small and middle-sized health and care organizations, we have developed a process navigator to guide providers of healthcare through the processes of innovation, the procurement of mature products, and their implementation in telehealth and telecare projects. Methods: A narrative overview identified health-technology-assessment-inspired models. Conversations with national and international colleagues identified project and implementation models. The origin of the included models was identified, and relevant articles were referred to to describe the essential principles, including the nature of stakeholder involvement and the evaluation processes when appropriate. Based on the inputs, we proposed the process navigator GoTO. Results: Six health-technology-assessment-inspired models, six project models, one implementation model, and one innovation model were identified and informed the creation of the GoTO process navigator. The navigator consists of four parts: inception (eight steps); materialization (three tracks, depending on the maturity of the planned solution); implementation (five steps); and the final assessment and evaluation. Conclusion: The GoTO process navigator is an intuitive guide for innovation, procurement, and implementation in telehealth and -care. The GoTo navigator can assist providers of digital health and care services throughout the process from the initial identification of goals to the final evaluation of outcomes.

Experiences With Hearing Health Care Services: What Can We Learn From Online Consumer Reviews?

Objective The aim of this study was to examine experiences of hearing health care services as described in online consumer reviews. Design This study used a cross-sectional design. Online consumer reviews about hearing health care services generated from Google.com to an open-ended question "Share details of your own experience at this place" and perceived overall experience (indicated on a 5-point rating scale: "very good" to "very poor") were extracted from 40 different cities across the United States. The open text contributed a text corpus of 9,622 unique consumer reviews. These responses were analyzed with the cluster analysis approach using an open-source automated text analysis software program, IRaMuTeQ, to identify key themes. Association between clusters and consumer experience ratings as well as consumer metadata (percentage of older adults in the city, region) were examined using the chi-square analysis. Results The majority of consumers appeared satisfied with their hearing health care services, with nearly 95% of consumers reporting "very good" and "good" on the global experience scale. The analysis of text responses resulted in seven clusters within two domains. Domain 1 (Clinical Processes) included the three clusters: administration processes, perceived benefits, and device acquisition. Domain 2 (Staff and Service Interactions) included the four clusters: clinician communications, staff professionalism, customer service, and provider satisfaction. Content relating to administration processes was associated with overall rating regarding the hearing health care service experience. Consumer's reviews relating to administration processes mostly described negative experiences, and these participants were more inclined to provide poorer overall experience ratings. In addition, city characteristics (i.e., percentage of older adults, region) had bearing toward what elements of hearing health care services are highlighted more in the consumer reviews. Conclusions Consumers comment on a variety of elements when describing their experiences with hearing health care services. Experiences reported in most clusters were generally positive, although some concerns in the "clinical process" are associated with lower satisfaction. Employing patient-centered strategies and ensuring patients have good experiences in the areas of concern may help improve both patient experience and their satisfaction. Supplemental Material https://doi.org/10.23641/asha.16455924.

Design of Generalized Search Interfaces for Health Informatics

In this paper, we investigate ontology-supported interfaces for health informatics search tasks involving large document sets. We begin by providing background on health informatics, machine learning, and ontologies. We review leading research on health informatics search tasks to help formulate high-level design criteria. We use these criteria to examine traditional design strategies for search interfaces. To demonstrate the utility of the criteria, we apply them to the design of ONTology-supported Search Interface (ONTSI), a demonstrative, prototype system. ONTSI allows users to plug-and-play document sets and expert-defined domain ontologies through a generalized search interface. ONTSI’s goal is to help align users’ common vocabulary with the domain-specific vocabulary of the plug-and-play document set. We describe the functioning and utility of ONTSI in health informatics search tasks through a workflow and a scenario. We conclude with a summary of ongoing evaluations, limitations, and future research.

The Role of Computer Skills in Personal Health Record Adoption Among Patients With Heart Disease: Multidimensional Evaluation of Users Versus Nonusers

Background

In the era of precision medicine, it is critical for health communication efforts to prioritize personal health record (PHR) adoption.

Objective

The objective of this study was to describe the characteristics of patients with heart disease that choose to adopt a PHR.

Methods

A total of 79 patients with chronic cardiovascular disease participated in this study: 48 PHR users and 31 nonusers. They completed 5 surveys related to their choice to use or not use the PHR: demographics, patient activation, medication adherence, health literacy, and computer self-efficacy (CSE).

Results

There was a significant difference between users and nonusers in the sociodemographic measure education (P=.04). There was no significant difference between users and nonusers in other sociodemographic measures: age (P=.20), sex (P=.35), ethnicity (P=.43), race (P=.42), and employment (P=.63). There was a significant difference between PHR users and PHR nonusers in CSE (P=.006).

Conclusions

In this study, we demonstrate that sociodemographic characteristics were not an important factor in patients’ use of their PHR, except for education. This study had a small sample size and may not have been large enough to detect differences between groups. Our results did demonstrate that there is a difference between PHR users and nonusers related to their CSE. This work suggests that incorporating CSE into the design of PHRs is critical. The design of patient-facing tools must take into account patients’ preferences and abilities when developing effective user-friendly health information technologies.

Development of an Instrument for Assessing the Maturity of Citizens for Consumer Health Informatics in Developing Countries: The Case of Chile, Ghana, and Kosovo

OBJECTIVE

 We aimed to develop a survey instrument to assess the maturity level of consumer health informatics (ConsHI) in low-middle income countries (LMIC).

METHODS

 We deduced items from unified theory of acceptance and use of technology (UTAUT), UTAUT2, patient activation measure (PAM), and ConsHI levels to constitute a pilot instrument. We proposed a total of 78 questions consisting of 14 demographic and 64 related maturity variables using an iterative process. We used a multistage convenient sampling approach to select 351 respondents from all three countries.

RESULTS

 Our results supported the earlier assertion that mobile devices and technology are standard today than ever, thus confirming that mobile devices have become an essential part of human activities. We used the Wilcoxon Signed-Rank Test (WSRT) and item response theory (IRT) to reduce the ConsHI-related items from 64 to 43. The questionnaire consisted of 10 demographic questions and 43 ConsHI relevant questions on the maturity of citizens for ConsHI in LMIC. Also, the results supported some moderators such as age and gender. Additionally, more demographic items such as marital status, educational level, and location of respondents were validated using IRT and WSRT.

CONCLUSION

 We contend that this is the first composite instrument for assessing the maturity of citizens for ConsHI in LMIC. Specifically, it aggregates multiple theoretical models from information systems (UTAUT and UTAUT2) and health (PAM) and the ConsHI level.

Hearing aid acquisition and ownership: what can we learn from online consumer reviews?

OBJECTIVE

To explore the publicised opinions of consumers actively participating in online hearing aid reviews.

DESIGN

A retrospective design examining data generated from an online consumer review website (www.HearingTracker.com). Qualitative data (open text responses) were analysed using the open source automated topic modelling software IRaMuTeQ (http://www.iramuteq.org/) to identify themes. Outputs were compared with quantitative data from the consumer reviews (short response questions exploring hearing aid performance and benefit, and some meta-data such as hearing aid brand and years of hearing aid ownership).

STUDY SAMPLE

1378 online consumer hearing aid reviews.

RESULTS

Six clusters within two domains were identified. The domain Device Acquisition included three clusters: Finding the right provider, device and price-point; Selecting a hearing aid to suit the hearing loss; Attaining physical fit and device management skills. The domain Device Use included three clusters: Smartphone streaming to hearing aids; Hearing aid adjustment using smartphone; and Hearing in noise.

CONCLUSIONS

Although online hearing aid consumers indicate positive performance on multiple-choice questions relating to hearing aid performance and benefit, their online reviews describe a number of barriers limiting their success. Hearing healthcare clinicians must employ a personalised approach to audiological rehabilitation to ensure individual clients' needs are met.

Online Medical Record Nonuse Among Patients: Data Analysis Study of the 2019 Health Information National Trends Survey

BACKGROUND

Online medical records are being used to organize processes in clinical and outpatient settings and to forge doctor-patient communication techniques that build mutual understanding and trust.

OBJECTIVE

We aimed to understand the reasons why patients tend to avoid using online medical records and to compare the perceptions that patients have of online medical records based on demographics and cancer diagnosis.

METHODS

We used data from the Health Information National Trends Survey Cycle 3, a nationally representative survey, and assessed outcomes using descriptive statistics and chi-square tests. The patients (N=4328) included in the analysis had experienced an outpatient visit within the previous 12 months and had answered the online behavior question regarding their use of online medical records.

RESULTS

Patients who were nonusers of online medical records consisted of 58.36% of the sample (2526/4328). The highest nonuser rates were for patients who were Hispanic (460/683, 67.35%), patients who were non-Hispanic Black (434/653, 66.46%), and patients who were older than 65 years (968/1520, 63.6%). Patients older than 65 years were less likely to use online medical records (odds ratio [OR] 1.51, 95% CI 1.24-1.84, P<.001). Patients who were White were more likely to use online medical records than patients who were Black (OR 1.71, 95% CI 1.43-2.05, P<.001) or Hispanic (OR 1.65, 95% CI 1.37-1.98, P<.001). Patients who were diagnosed with cancer were more likely to use online medical records compared to patients with no cancer (OR 1.31, 95% CI 1.11-1.55, 95% CI 1.11-1.55, P=.001). Among nonusers, older patients (≥65 years old) preferred speaking directly to their health care providers (OR 1.76, 95% CI 1.35-2.31, P<.001), were more concerned about privacy issues caused by online medical records (OR 1.79, 95% CI 1.22-2.66, P<.001), and felt uncomfortable using the online medical record systems (OR 10.55, 95% CI 6.06-19.89, P<.001) compared to those aged 18-34 years. Patients who were Black or Hispanic were more concerned about privacy issues (OR 1.42, 1.09-1.84, P=.007).

CONCLUSIONS

Studies should consider social factors such as gender, race/ethnicity, and age when monitoring trends in eHealth use to ensure that eHealth use does not induce greater health status and health care disparities between people with different backgrounds and demographic characteristics.

Establishing criterion validity for the Revised Critical Nutrition Literacy Tool in U.S. college students

BACKGROUND

Critical nutrition literacy (CNL) plays an important role in how college students make everyday decisions about nutrition choices. Increasing CNL is an aim of many introductory nutrition courses, but there are limited instruments measuring this construct. This study aimed to assess the changeability of CNL and the relationship between CNL and markers of diet quality in young adults.

DESIGN

This was a two-phase research project consisting of a nonexperimental, pre-post study and a cross-sectional assessment from 2018 to 2019. Participants were U.S. college students, 18-24 years old, recruited from introductory-level courses from three participating universities, located in Rhode Island, West Virginia, and New Jersey.

SUBJECTS AND METHODS

Interventions consisted of (1) a 4-credit, 13-week nutrition course and (2) a cross-sectional, online behavior, environment, and perception survey. CNL was measured using the Revised CNL Tool (CNLT-R) instrument across both phases. Measures for phases include: (1) the changeability of CNL and (2) the relationship between CNL and markers of diet quality.

ANALYSIS

Paired t-tests and multivariate analysis of variance were utilized through SPSS version 25.0.

RESULTS

CNL score significantly increased from baseline to postintervention from 3.38 ± 0.48 to 3.61 ± 0.55 (P = 0.014). There was an overall significant effect of CNL on markers of diet quality, such as cups of fruits and vegetables (F/V) and teaspoons of added sugar (F [2,1321] = 3.12, P < 0.05; Wilks' Λ = 0.99).

CONCLUSIONS

This research found that an introduction to nutrition course was associated with an increase in CNL and that CNL is related to diet quality. The instrument could be used by nutrition educators as an outcome assessment. Future research should investigate other components of the CNL construct as well as predictive validity.

Opportunities for the use of health information technology to support research

In the last decade, expanding use of health information technology (IT) across the United States has created opportunities for use of electronic health data for health services and biomedical research, but efforts may be hampered by limited data access, data quality, and system functionality. We identify five opportunities to advance the use of health IT for health services and biomedical research, which informed a federal government-led, collaborative effort to develop a relevant policy and development agenda. In particular, the health IT infrastructure should more effectively support the use of electronic health data for research; provide adaptable technologies; incorporate relevant research-related functionality; support patient and caregiver engagement in research; and support effective integration of knowledge into practice. While not exhaustive, these represent important opportunities that the biomedical and health informatics communities can pursue to better leverage health IT and electronic health data for research.

Leveraging Interdisciplinary Teams to Develop and Implement Secure Websites for Behavioral Research: Applied Tutorial

Behavioral researchers are increasingly using interactive digital platforms, either as standalone or supplementary intervention tools, to facilitate positive changes in research participants’ health habits. Research-oriented interactive websites optimally offer a variety of participatory mediums, such as blogs, user-driven content, or health activities. Owing to the multidirectional features of interactive websites, and a corresponding need to protect research participants’ identity and data, it is paramount that researchers design ethical platforms that ensure privacy and minimize loss of anonymity and confidentiality. Authentication (ie, digital verification of one’s identity) of interactive sites is one viable solution to these concerns. Although previous publications have addressed ethical requirements related to authenticated platforms, few applied guidelines in the literature facilitate adherence to ethical principles and legally compliant study protocols during all phases of research website creation (feasibility, design, implementation, and maintenance). Notably, to remain compliant with ethical standards and study protocols, behavioral researchers must collaborate with interdisciplinary teams to ensure that the authenticated site remains secure and usable in all stages of the project. In this tutorial, we present a case study conducted at a large research university. Through iterative and practical recommendations, we detail lessons learned from collaborations with the Institutional Review Board, legal experts, and information technology teams. Although the intricacies of our applied tutorial may require adaptations based on each institution’s technological capacity, we are confident that the core takeaways are universal and thus useful to behavioral researchers creating ethically responsible and compliant interactive websites.

Fibromyalgia Impact Reduction Using Online Personal Health Informatics: Longitudinal Observational Study

Background

Personal health informatics have the potential to help patients discover personalized health management strategies that influence outcomes. Fibromyalgia (FM) is a complex chronic illness requiring individualized strategies that may be informed by analysis of personal health informatics data. An online health diary program with dynamic feedback was developed to assist patients with FM in identifying symptom management strategies that predict their personal outcomes, and found reduced symptom levels associated with program use.

Objective

The aim of this study was to determine longitudinal associations between program use and functional impact of FM as measured by scores on a standardized assessment instrument, the Fibromyalgia Impact Questionnaire (FIQ).

Methods

Participants were self-identified as diagnosed with FM and recruited via online FM advocacy websites. Participants used an online health diary program (“SMARTLog”) to report symptom ratings, behaviors, and management strategies used. Based on single-subject analysis of the accumulated data over time, individualized recommendations (“SMARTProfile”) were then provided by the automated feedback program. Indices of program use comprised of cumulative numbers of SMARTLogs completed and SMARTProfiles received. Participants included in this analysis met a priori criteria of sufficient program use to generate SMARTProfiles (ie, ≥22 SMARTLogs completed). Users completed the FIQ at baseline and again each subsequent month of program use as follow-up data for analysis. Kendall tau-b, a nonparametric statistic that measures both the strength and direction of an ordinal association between two repeated measured variables, was computed between all included FIQ scores and both indices of program use for each subject at the time of each completed FIQ.

Results

A total of 76 users met the a priori use criteria. The mean baseline FIQ score was 61.6 (SD 14.7). There were 342 FIQ scores generated for longitudinal analysis via Kendall tau-b. Statistically significant inverse associations were found over time between FIQ scores and (1) the cumulative number of SMARTLogs completed (tau-b=–0.135, P<.001); and (2) the cumulative number of SMARTProfiles received (tau-b=–0.133, P<.001). Users who completed 61 or more SMARTLogs had mean follow-up scores of 49.9 (n=25, 33% of the sample), an 18.9% drop in FM impact. Users who generated 11 or more new SMARTProfiles had mean follow-up scores of 51.8 (n=23, 30% of the sample), a 15.9% drop.

Conclusions

Significant inverse associations were found between FIQ scores and both indices of program use, with FIQ scores declining as use increased. Based on established criteria for rating FM severity, the top one-third of users in terms of use had clinically significant reductions from “severe” to “moderate” FM impact. These findings underscore the value of self-management interventions with low burden, high usability, and high perceived relevance to the user.

Trial Registration

ClinicalTrials.gov NCT02515552; https://clinicaltrials.gov/ct2/show/NCT02515552

Clinician Perspectives on mRehab Interventions and Technologies for People with Disabilities in the United States: A National Survey

Mobile health and mobile rehabilitation (mHealth and mRehab) services and technologies have attracted considerable interest from healthcare providers, technology vendors, rehabilitation engineers, investors and policy makers in recent years. Successful adoption and use of mHealth/mRehab requires clinician support and engagement, including the ability to identify appropriate use cases and possible barriers to use for themselves and their patients, and acquire adequate knowledge and confidence using mHealth/mRehab interventions. This article reports results from a survey of rehabilitation clinicians in the United States on their attitudes, experience, expectations and concerns regarding mHealth/mRehab interventions and technologies. Over 500 clinicians in physical, occupational, speech, recreation and psychological therapy professions, among others, participated in the survey. Respondents reported that an overwhelming majority of their patients need additional therapy after discharge from inpatient environments, and over half of outpatients need additional therapy between visits. A large majority reported prescribing specific exercises and interventions for patients to work on outside of the clinic. However, only 51% reported being comfortable integrating mRehab technology into their practice; and only 23% feel knowledgeable about rehabilitation technology currently available. Technologies to support mRehab are maturing rapidly. Clinicians recognize the need for mRehab, but their knowledge and confidence prescribing mRehab represents a significant barrier to adoption.

The Role of the Sharing Economy and Artificial Intelligence in Health Care: Opportunities and Challenges

Health care systems worldwide have been influenced by the globally growing trend toward a sharing economy and will likely advance with these trends in the near future. Therefore, based on peer-to-peer relationships between individuals, sharing health care works by renting medical staff, facilities, and other medical resources. Medical data innovation, integration, analysis, and sharing have the potential to dramatically change the current pattern of the health care system and to provide precise and predictive medical assessment for individuals in the future. In addition, artificial intelligence could be useful in the fields of both clinical medicine and medical research and help to minimize the scarcity of human resources and broaden the role of humans in health care.

Present and Future Trends in Consumer Health Informatics and Patient-Generated Health Data

Objectives: Consumer Health Informatics (CHI) and the use of Patient-Generated Health Data (PGHD) are rapidly growing focus areas in healthcare. The objective of this paper is to briefly review the literature that has been published over the past few years and to provide a sense of where the field is going. Methods: We searched PubMed and the ACM Digital Library for articles published between 2014 and 2016 on the topics of CHI and PGHD. The results of the search were screened for relevance and categorized into a set of common themes. We discuss the major topics covered in these articles. Results: We retrieved 65 articles from our PubMed query and 32 articles from our ACM Digital Library query. After a review of titles, we were left with 47 articles to conduct our full article survey of the activities in CHI and PGHD. We have summarized these articles and placed them into major categories of activity. Within the domain of consumer health informatics, articles focused on mobile health and patient-generated health data comprise the majority of the articles published in recent years. Conclusions: Current evidence indicates that technological advancements and the widespread availability of affordable consumer-grade devices are fueling research into using PGHD for better care. As we observe a growing number of (pilot) developments using various mobile health technologies to collect PGHD, major gaps still exist in how to use the data by both patients and providers. Further research is needed to understand the impact of PGHD on clinical outcomes.

The Quality of Online Health-Related Information – an Emergent Consumer Health Issue

The Internet has become one of the main means of communication used by people who search for health-related information. The quality of online health-related information affects the users’ knowledge, their attitude, and their risk or health behaviour in complex ways and influences a substantial number of users in their decisions regarding diagnostic and treatment procedures.

The aim of this review is to explore the benefits and risks associated with using the Internet as a source of health-related information; the relationship between the quality of the health-related information available on the Internet and the potential risks; the multiple conceptual components of the quality of health-related information; the evaluation criteria for quality health-related information; and the main approaches and initiatives that have been implemented worldwide to help improve users’ access to high-quality health-related information.