Users of Internet health information: differences by health status

Preferred format and strategies for seeking and trusting online health information: a survey of cardiology outpatient attendees across three New Zealand hospitals

Introduction The volume and quality of online health information requires consumers to be discerning. Aim This study aimed to explore consumer Internet use for health information, preferred format and what factors helped them to trust the source. Methods A cross-sectional study was conducted in 2016-2017 with adults attending three cardiology outpatient clinic sites using a short paper-based survey. The survey included questions regarding online health information use and perceived trustworthiness with opportunities for free text responses. Survey data were summarised with key questions adjusted by age group, gender and ethnicity using logistic regression. Results Of the 708 respondents (51% women, 66% aged 45-74 years, 16% Māori, 12% Pacific), 73% had sought health information online (64% in the previous 12 months), commonly for medication side effects, their health condition and self-help. Most (65%) were successful, although Pacific respondents reported a lower likelihood of search success compared to Europeans. Younger age groups were more concerned about information quality. Fact sheets (80%) were the most popular format and for all ethnic groups, followed by short videos (31%) and discussion groups (23%). Trusting online information required many strategies with 72% wanting health professionals to recommend websites. Discussion Online health information seeking is a norm for consumers, with simple fact sheets being the preferred format to build knowledge and skills. With the rising tide of misinformation, health portal providers need to offer accurate and easy-to-read fact sheets in their suite of formats and health professionals need to support consumers guiding them to trusted websites.

Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians' Views on Access, Expectations, and Communication

BACKGROUND

Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China.

OBJECTIVE

We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care.

METHODS

We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero).

RESULTS

Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients' expectations and the reality of limitations regarding both physicians' availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care.

CONCLUSIONS

This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients' expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults.

Utilization of, satisfaction toward, and challenges for Internet-based healthcare services provided by primary health institutions: Evidence from China

Background

The rapid development of "Internet plus healthcare" in China has provided new ways for the innovative development of primary healthcare. In addition, a series of favorable policies have been issued to promote Internet-based healthcare services in primary health institutions.

Objective

The aim of this study was to describe the utilization of, satisfaction toward, and challenges faced by Internet-based healthcare services provided by primary health institutions in China.

Methods

A self-designed structured questionnaire was employed to collect related data in January 2022 through Credamo. The questionnaire mainly included sociodemographic characteristics, health-related information, utilization of, satisfaction toward, and challenges faced by Internet-based healthcare services provided by primary health institutions. Descriptive analysis was used to describe the sociodemographic characteristics, utilization, satisfaction, and challenges by subgroups. The Wilcoxon rank-sum test was carried out to examine the differences in satisfaction with Internet-based healthcare services between participants who ever received these services and those who did not. A multiple logistic regression model was also used to examine the factors influencing the utilization of Internet-based healthcare services provided by primary health institutions.

Results

A total of 10,600 residents were included in the final analysis, of whom 5,754 (54.3%) were women. Overall, 51.3% (5,434) of the total participants ever used Internet-based healthcare services provided by primary health institutions. Among those who used Internet-based healthcare services, the most widely used services were procedure-related consultation services (63.7%). The satisfaction among those who ever used it was significantly higher than that among those who did not (84.7 vs. 45.4%; p-value < 0.001). One of the biggest challenges (69.3%) expressed by the residents was that it was difficult for the elderly to use Internet-based services, followed by community doctors with low capacity of providing primary care online (49.0%) and residents were worried about the information security and privacy protection (48.5%). Younger people, people with lower education levels, and people with chronic diseases were significantly more likely to use Internet-based healthcare services provided by primary health institutions (P < 0.05).

Conclusion

Among 10,600 residents surveyed in China in 2022, more than half of the people used Internet-based healthcare services provided by primary health institutions, and most of them were satisfied, although subgroups significant differences existed. The most common use was procedure-related (e.g., online registration and result query), and several challenges of using Internet-based healthcare services exist (e.g., information safety and usage among elderly people). Therefore, it is important to further improve Internet-based primary healthcare services based on the population perception of achieving healthy China in 2030.

Seeking health information online among U.S. pregnant women: findings from the 2009-2018 National Health Interview Surveys

Seeking health information online has gained in popularity. However, few studies have investigated seeking health information online among U.S. pregnant women. The aim of this study was to investigate the patterns, trends, and characteristics of pregnant women in the U.S. who seek health information online. We obtained data from the National Health Interview Survey from 2009 to 2018. The study population consisted of women aged 18 to 49 years who self-reported being pregnant. Complex survey weighting and Chi-squared tests were used to evaluate trends and compare characteristics of online users and nonusers. Multivariable logistic regression analyses were used to evaluate characteristics associated with seeking health information online. Significantly more pregnant women sought health information online in 2018 compared to 2009 (72.9 percent, standard error [SE]: 3.3, 95 percent confidence interval [CI]: 66.3 percent-79.5 percent, vs. 60.7 percent, SE: 3.3, 95 percent CI: 54.0 percent-67.4 percent, p < .01). Pregnant women who were identified as white or Black, who had more education, and who had higher incomes were significantly more likely to report seeking health information online. Healthcare providers should actively initiate conversations to address the safety, accuracy, and reliability of online health information for their pregnant patients.

An infodemiology study on exploring the quality and reliability of colorectal cancer immunotherapy information

Background

Immunotherapy is a new treatment modality which promises hope for advanced colorectal cancer patients. To our knowledge, no previous studies have evaluated the quality of patient information available on this topic online.

Objective

This study will explore the quality and reliability of colorectal cancer immunotherapy information using the Journal of the American Medical Association (JAMA) and DISCERN tools.

Methods

Design thinking methodology was integrated with systematic scoping reviews framework to inform our descriptive observational media analysis study. Google Chrome was used to run four searches using prespecified search terms selected according to the top patient concerns about immunotherapy. The first 20 relevant results were identified (n = 80) and then duplicates were removed. Descriptive narrative univariate and bivariate analysis was done for the relevant variables.

Results

The total of included websites was 17. Most websites score <3 points on JAMA and fair/poor on DISCERN. Most of the websites that score ≥3 points on JAMA and excellent/good on DISCERN have a charity affiliation. A total of 58.8% of the websites present the date, 41.2% demonstrate authorship, and sources are mentioned in 29.4% of the websites. Lack of content was noticed in providing the prognosis of patients if no treatment is given, clear aim and the effect of treatments on patient's quality of life.

Conclusion

Assessing the reliability of information about cancer treatments online remains a challenge. Further research is required to understand the patient perceptions and use of online information and whether it has an impact on their behavioural health outcomes.

Understanding the Antecedents of the Routine Use of Mobile Health Services: A Person-Technology-Health Framework

Although numerous studies have been conducted to understand the antecedents of usage of mobile health (mHealth) services, most of them solely focus on characteristics of mHealth services themselves but neglect taking users' psychological and health-related factors into consideration. Besides, the comprehensive understanding of what influences users' routine use intentions regarding mHealth services is lacking. Therefore, this study proposes a person-technology-health framework that underlines how personal factors (e.g., personal innovativeness in IT), technological factors (e.g., trust), and health factors (e.g., perceived health severity) jointly influence individuals' routine use intentions regarding mHealth services. The proposed research model and related hypotheses were tested based on survey data from 270 respondents. The results indicate that personal innovativeness in IT, trust, and perceived health severity are important for enhancing routine use intention of mHealth services. Specifically, in situations of high perceived health severity, trust relates less positively to routine use intention than personal innovativeness in IT. In contrast, in situations of low perceived health severity, trust relates more positively to routine use intention than personal innovativeness in IT. The research findings extend the existing literature on routine use intention related to mHealth services and provide significant implications for practitioners.

Impacts of the Internet on Health Inequality and Healthcare Access: A Cross-Country Study

Access to information and resources through the Internet has become an increasingly critical aspect of contemporary life. Based on the WHO Health Equity Assessment Toolkit (HEAT) and cross-country panel data, this paper investigates the effect of Internet access on health inequality across different income groups. The results indicate that access to the Internet significantly improves the average health condition and alleviates health inequality. In addition, employing cross-country data from the Global Burden of Disease (GBD) database, this paper further examines the social and economic determinants of access to healthcare. Specifically, it is found that Internet access significantly facilitates healthcare access and mitigates the negative impact of income inequality on healthcare access. Considered together, these findings shed light on the importance of the Internet in reducing health inequality and improving healthcare access.

Increasing Perceived Risk of Opioid Misuse: The Effects of Concrete Language and Image

Risk perception is a critical determinant for individuals' health behavior change, especially for behaviors with distal future consequences. Building on construal-level theory, this study investigates if and how thinking concretely about the negative consequences of opioid misuse influences people's risk perception toward opioid misuse. Two message cues - images and concrete (vs. abstract) language - are proposed to influence concrete thinking and perceived temporal distance, which in turn influence risk perception directly and through negative affect. Using a factorial online experiment with Amazon Mechanical Turk workers (N = 220), this study found that messages using concrete language made people think more concretely about the negative consequences of opioid misuse. Perceived concreteness, in turn, increased risk perception and negative affect. Negative affect also increased risk perception. The use of images decreased perceived temporal distance, which in turn, changed risk perception through its influence on negative affect. Theoretical and practical implications are discussed.

Older age and online health information search behaviors: The mediating influence of executive functions

INTRODUCTION

Searching the internet for health-related information is a complex and dynamic goal-oriented process that ostensibly places demands on executive functions, which are higher-order cognitive abilities that can deteriorate with older age. This study examined the effects of older age on electronic health (eHealth) search behavior and the potential mediating influence of executive functions.

METHOD

Fifty younger adults (≤ 35 years) and 41 older adults (≥50 years) completed naturalistic eHealth search tasks involving fact-finding (Fact Search) and symptom determination (Symptom Search), a neurocognitive battery, and a series of self-report questionnaires.

RESULTS

Multiple regression models controlling for potentially confounding psychiatric symptoms, health conditions, literacy, and demographic variables revealed that older adults were slower and less accurate than younger adults on the eHealth Fact Search task, but not on the eHealth Symptom Search task. Executive functions mediated the relationship between age and Fact and Symptom Search accuracy, independent of basic processing speed and attention. Parallel mediation models showed that episodic memory was not an independent mediator of age and search accuracy for either eHealth task once speed/attention and executive functions were included.

CONCLUSIONS

Older adults can experience difficulty searching the internet for some health-related information, which is at least partly attributable to executive dysfunction. Future studies are needed to determine the benefits of training in the organizational and strategic aspects of internet search for older adults and whether these findings are applicable to clinical populations with executive dysfunction.

Feel Worried, Overloaded, or Fatalistic? The Determinants of Cancer Uncertainty Management Preferences

Uncertainty in the context of cancer involves a complex and conflicting decision-making process. Individual preferences of seeking or avoiding information in the decisions of maintaining, reducing, or increasing uncertainty often depend on key cancer-related beliefs. The present study investigates whether cancer worry (CW), information overload (CIO), or fatalism (CF) can predict four constructs of uncertainty management preferences - avoid to maintain hope, avoid insufficient information, seek to increase uncertainty, and seek to reduce uncertainty. A hybrid model with structural and measurement components was specified and tested. The model analysis shows that cancer-related beliefs influenced individuals' needs and preferences for uncertainty management through seeking or avoiding information. CW was positively related to all but avoiding insufficient information. CIO was positively associated with all four preferences. CF was only associated with avoiding to maintain uncertainty. Theoretical and practical implications were discussed.

Use of Digital Health Information for Health Information Seeking Among Men Living With Chronic Disease: Data From the Health Information National Trends Survey

Although diabetes education plays an important role in self-management for people living with diabetes, male health “help-seeking” lags far behind women. These gender-related “help-seeking” disparities often result in males being less engaged in their health care, which subsequently leads to poorer health outcomes among males. In this cross-sectional study, we used data from the 2017 Health Information National Trends Survey (HINTS) to identify factors that may contribute to communication inequalities between males and females. A hierarchical {linear/logistic} regression model was used to examine factors associated with online health information seeking among males living with diabetes. The results suggest that education, income, age, identifying as Hispanic, being a smoker, using a device to track progress toward a health-related goal, and using device to seek health information were all related to eHealth sum scores. Future research should consider testing applications among various at-risk groups to determine if the technology itself is becoming a barrier to eHealth.

Socioeconomic and behavioural factors associated with access to and use of Personal Health Records

BACKGROUND

Access to and use of digital technology are more common among people of more advantaged socioeconomic status. These differences might be due to lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of Personal Health Records (PHR): desire, intentions and physical access to PHR.

METHODS

A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). Exploratory factor analysis was performed to group items derived from the UTAUT model. We applied linear and logistic regressions controlling for country-level heterogeneity, health and demographic factors.

RESULTS

A total of 829 individuals aged over 18 completed the questionnaire. Socioeconomic inequalities were present in the access to and use of PHR. Education and income played a significant role in individuals' desire to access their PHR. Being older than 65 years, and migrant, were negatively associated with desire to access PHR. An income gradient was found in having physical access to PHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use PHR. In fully adjusted models testing the contribution of UTAUT-derived factors, individuals who perceived PHRs to be useful and had the necessary digital skills were more inclined to use their PHR regularly. Social influence, support and lack of anxiety in using technology were strong predictors of regular PHR use.

CONCLUSION

The findings highlight the importance of considering all stages in PHR use: desire to access, physical access and intention to regularly use PHRs, while paying special attention to migrants and people with less advantaged socioeconomic backgrounds who may feel financial constraints and are not able to exploit the potential of PHRs. As PHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could reduce health inequalities and advance health equity.

Relationship Between Internet Use and Change in Health Status: Panel Study of Young Adults

Background

Using the internet for health information is a widespread phenomenon documented in considerable scholarship. Less common, however, is the analysis of panel data to examine how internet use may relate to change in health status over time.

Objective

This study examines whether internet use and internet use related to health are associated with a change in health status among young adults.

Methods

We used a unique panel survey data set collected about young adults’ internet use in 2012 and 2016 (n=384). We applied logistic regression to examine the relationships between sociodemographics, internet experiences, frequency of health-related internet use, and sharing health content online with change in health status over time. We additionally examined the variables characterizing sharing health content online (via Facebook, Twitter, and email) in separate models.

Results

In the second wave, over half (236/384, 61.5%) of the sample used the internet for health at least weekly. Approximately one-third (141/384, 36.7%) used Facebook for health-content sharing, while using Twitter and email for sharing health content were far less frequent (14/384, 3.6%, and 55/384, 14.3%, respectively). A change in health status occurred for 43.0% (165/384) of the sample; 18.5% (71/384) reported an improvement while 24.5% (94/384) reported a decline. Greater frequency of internet use was associated with health decline over time (B=–0.58, P=.02). We also found that frequent health-related internet use was related to enhanced health or maintained health (B=0.58, P=.03). Sharing health content on social media or email, however, was not related to young adults’ health changes.

Conclusions

Young adults exhibit a pattern of using the internet for health that influences their health status. Our finding that frequent health-related internet use may promote improved or maintained health suggests that this type of online activity might also support healthy living.

Online Health Resource Use by Individuals With Inflammatory Bowel Disease: Analysis Using the National Health Interview Survey

Background

The internet has enabled convenient and efficient health information searching which is valuable for individuals with chronic conditions requiring some level of self-management. However, there is little research evaluating what factors may impact the use of the internet for health-related tasks for specific clinical populations, such as individuals with inflammatory bowel diseases.

Objective

Our goal was to investigate the factors that influence internet use in acquiring health information by individuals with inflammatory bowel diseases. Specifically, we identified factors associated with internet searching behavior and using the internet for completing health-related tasks.

Methods

We used 2016 National Health Interview Survey weighted data to develop logistic regression models to predict the likelihood that individuals with inflammatory bowel diseases would use the internet for 2 types of tasks: seeking health information through online searches and using the internet to perform health-related tasks including scheduling appointments and emailing care providers.

Results

2016 National Health Interview Survey weighted data include more than 3 million weighted adult respondents with inflammatory bowel diseases (approximately 1.29% of adults in the weighted data set). Our results suggest that approximately 66.3% of those with inflammatory bowel diseases reported using the internet at least once a day, and approximately 14.7% reported being dissatisfied with their current health care. About 62.3% of those with inflammatory bowel diseases reported that they had looked up health information online, 16.3% of those with inflammatory bowel diseases reported that they had scheduled an appointment with a health care provider online, and 21.6% reported having used a computer to communicate with a health provider by email. We found that women who were self-regulating their care were more likely to look up health information online than others. Both middle-aged and older adults with inflammatory bowel diseases who were unsatisfied with their current health care were less likely to look up health information online. Frequent internet users who were worried about medical costs were more likely to look up health information online. Similarly, the results from our statistical models suggest that individuals with inflammatory bowel diseases who were frequent internet users were more likely to use the internet for specific health-related tasks. Additionally, women with inflammatory bowel diseases who reported being married were less likely to use the internet for specific health-related tasks.

Conclusions

For those with inflammatory bowel diseases, there are additional socioeconomic and behavioral factors that impact the use of the internet for health information and health-related tasks. Future research should evaluate how these factors moderate the use of the internet and identify how online resources can support clinical populations in ways that improve access to information, support health self-management, and subsequently improve health outcomes.

Neurocognitive Correlates of Internet Search Skills for eHealth Fact and Symptom Information in a Young Adult Sample

As the Covid 19 crisis has revealed, the internet is a first-line tool for learning critical health-related information. However, internet searches are a complex and dynamic process that can be fraught with subtleties and potential error. The mechanics of searching for and using electronic health (eHealth) information is ostensibly cognitively demanding; yet we know little about the role of neurocognitive abilities in this regard. Fifty-six young adults completed two naturalistic eHealth search tasks: fact-finding (eHealth Fact) and symptom-diagnosis (eHealth Search). Participants also completed neurocognitive tests of attention, psychomotor speed, learning/memory, and executive functions. Shorter eHealth symptom-diagnosis search time was related to better executive functions, while better eHealth symptom-diagnosis search accuracy was related to better episodic and prospective memory. In contrast, neither eHealth Fact search time nor its accuracy were related to any of the neurocognitive measures. Our findings suggest a differential relationship between neurocognitive abilities and eHealth search behaviors among young adults such that higher-order abilities may be implicated in eHealth searches requiring greater synthesis of information. Future work should examine the cognitive architecture of eHealth search in persons with neurocognitive disorders, as well as that of other aspects of eHealth search behaviors (e.g., search term generation, website reliability, and decision-making).

Studying health-related internet and mobile device use using web logs and smartphone records

Many people use the internet to seek information that will help them understand their body and their health. Motivations for such behaviors are numerous. For example, users may wish to figure out a medical condition by searching for symptoms they experience. Similarly, they may seek more information on how to treat conditions they have been diagnosed with or seek resources on how to live a healthy life. With the ubiquitous availability of the internet, searching and finding relevant information is easier than ever before and a widespread phenomenon. To understand how people use the internet for health-related information, we use data from a sample of 1,959 internet users. A unique combination of data containing four months of users' browsing histories and mobile application use on computers and mobile devices allows us to study which health websites they visited, what information they searched for and which health applications they used. Survey data inform us about users' socio-demographic background, medical conditions and other health-related behaviors. Results show that women, young users, users with a university education and nonsmokers are most likely to use the internet and mobile applications for health-related purposes. On search engines, internet users most frequently search for pharmacies, symptoms of medical conditions and pain. Moreover, users seem most interested in information on how to live a healthy life, alternative medicine, mental health and women's health. With this study, we extend the field's understanding of who seeks and consumes health information online, what users look for as well as how individuals use mobile applications to monitor their health. Moreover, we contribute to methodological research by exploring new sources of data for understanding humans, their preferences and behaviors.

Searching the Internet for Infertility Information: A Survey of Patient Needs and Preferences

Background

Given the complexity of infertility diagnoses and treatments and the convenience of the internet for finding health-related information, people undergoing infertility treatments often use Web-based resources to obtain infertility information and support. However, little is known about the types of information and support resources infertility patients search for on the internet and whether these resources meet their needs.

Objective

The aims of this study were to (1) examine what individual factors, namely, demographic characteristics and distress, are associated with searching the internet for different types of infertility-related information and support resources and (2) determine whether Web-based resources meet the needs of patients.

Methods

Men and women seeking infertility care responded to a survey assessing use of Web-based resources for accessing infertility-related information and support. The survey further assessed satisfaction with Web-based resources as well as perceived stress and depressive symptomatology.

Results

A total of 567 participants, including 254 men and 313 women, completed the survey. Most participants (490/558, 87.8%) had searched the internet for infertility information and support. Searchers were more likely to be women (P<.001), highly educated (P=.04), long-term patients (P=.03), and more distressed (P=.04). Causes of infertility, treatment options, and scientific literature about infertility were the three most frequently searched topics, whereas ways to discuss treatment with family and friends as well as surrogacy and ways to find peer support were the three least searched topics. Of those who searched the internet, 70.9% (346/488) indicated that their needs were met by Web-based information, whereas 29.1% (142/488) said that their needs were not met. Having unmet needs was related to greater levels of perceived stress (P=.005) and depressive symptomatology (P=.03).

Conclusions

This study provides evidence for the important role of the internet in accessing infertility information and support and for the ability of Web-based resources to meet patients’ needs. However, although distressed patients reported particularly high rates of searching, their needs were not always met, suggesting that they may benefit from alternative sources of information and support or guidance from health care providers when searching the internet.

Factors influencing online health information seeking behaviour among patients in Kwahu West Municipal, Nkawkaw, Ghana

Over the years, health care delivery and ways of accessing health information have transformed rapidly through the use of technology. The internet has played a key role in this advancement by serving as an important source of health information to people regardless of their location, language or condition. This cross sectional study was conducted in the Kwahu West Municipal to determine factors influencing online health information seeking behaviours among patients. Three hospitals in the municipality were purposively selected for the study. Outpatients attending these facilities were systematically selected and data was collected using structured interviewer administered questionnaire. The study findings revealed that internet usage rate among patients was 85.8%. However, only 35.7% of patients ever used the internet to access health information. Sex, education and average monthly income were significant factors associated with online health information seeking. The study also showed that, computer and internet experience factors increased the probability of using internet for health information. After adjusting for confounding factors; being employed, earning higher income and owning a computer were positive predictors of online health information seeking. It is important to explore other means of reducing the disparity in information access by improving skill and health literacy among the low social class who cannot afford internet ready devices. Health care providers should recognize that patients are seeking health information from the internet and should be prepared to assist and promote internet user skills among their patients.

Online Support Group Participation and Social Support: Incorporating Identification and Interpersonal Bonds

An increasing number of people with chronic diseases exchange social support using online support groups (OSGs). However, there is little understanding of group communication mechanisms that underpin the relationship between OSG participation and social support. Drawing on Prentice, Miller, and Lightdale’s common-identity and common-bond framework, we propose and test a theoretical model that explains group communication mechanisms through which members’ participation influences their perceived social support. In the process, we identified and empirically validated a three-factor solution for an OSG participation scale. Based on 356 users across 12 popular OSGs, we find that two group communication mechanisms—identification with the community and interpersonal bonds with other members—mediate the relationship between OSG participation and perceived social support. Specifically, identification has a stronger mediating effect than interpersonal bonds in the relationship between OSG participation and perceived social support. We also discuss theoretical and practical implications.

The Impact of Superfast Broadband, Tailored Booklets for Households, and Discussions With General Practitioners on Personal Electronic Health Readiness: Cluster Factorial Quasi-Randomized Control Trial

Background

Electronic health (eHealth) may improve health outcomes, but many people remain digitally excluded. Personal readiness to use the internet for health may be limited by lack of internet infrastructure, personal skills, social support, service provision, and cost. The impact of interventions to reduce these barriers is unknown. From 2011, the British Government supported the implementation of “superfast” broadband (Superfast) across the rural county of Cornwall. This provided the opportunity to assess the impact of interventions at regional, practice, and household levels.

Objective

This study aimed to assess the impact of 3 interventions on personal eHealth readiness: (1) regional-level implementation of Superfast, (2) practice-level discussions with general practitioners to encourage greater internet use in health service provision, and (3) household-level tailored booklets providing information to help improve personal skills in eHealth.

Methods

This was a cluster quasi-randomized factorial controlled trial. Implementation of Superfast was monitored, and postcodes were classified as having early or late availability. An algorithm selected 78 from 16,385 eligible postcodes to minimize the possibility of overlap between general practices and ensure a balance of urban and rural areas; 1388 households were randomly selected from the 78 postcodes and allocated to the 8 (2 × 2 × 2) study arms. A modified version of the Personal eHealth Readiness Questionnaire was used to compare scores (0 to 10) and 4 components (personal, provision, support, and economic) from baseline (August 2013) to the 18-month follow-up between the 8 arms, to assess the impact of interventions. We compared SDs of scores to assess changes in eHealth inequalities.

Results

eHealth readiness improved over 18 months from 4.36 out of 10 to 4.59 out of 10 (t₂₃₅=4.18; P<.001; CI=0.13 to 0.35), resulting from increases in personal and provision components of the score (t₂₅₅=3.191; P=.002 and t₂₅₈=3.410; P=.001). However, there were no significant differences between the 3 interventions, either singly or in combination using intention-to-treat analysis. The proportion of internet users did not significantly increase (79.2%, 205/259 to 81.5%, 211/259) and mobile use was significantly greater (50.5%, 101/199 to 64.8%, 129/199). There was no change in eHealth inequality.

Conclusions

People in Cornwall became more ready to adopt eHealth services, increasing both their personal ability to use eHealth and their methods of access. The implementation of Superfast may have contributed to this; we are certain that our other 2 interventions did not. This increased eHealth readiness did not cause a larger digital divide. The study illustrates the complexity of conducting a randomized controlled trial to assess the impact of interventions at regional, practice, and household levels. Our method may be of use to others.

Trial Registration

ClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT02355808 (Archived by WebCite at http://www.webcitation.org/75oEz0E1x)

Identifying Consumers Who Search for Long-Term Care on the Web: Latent Class Analysis

Background

Because the internet has become a primary means of communication in the long-term care (LTC) and health care industry, an elevated understanding of market segmentation among LTC consumers is an indispensable step to responding to the informational needs of consumers.

Objective

This exploratory study was designed to identify underlying market segments of the LTC consumers who seek Web-based information.

Methods

Data on US adult internet users (n=2018) were derived from 2010 Pew Internet and America Life Project. Latent class analysis was employed to identify underlying market segments of LTC Web-based information seekers.

Results

Web-based LTC information seekers were classified into the following 2 subgroups: heavy and light Web-based information seekers. Overall, 1 in 4 heavy Web-based information seekers used the internet for LTC information, whereas only 2% of the light information seekers did so. The heavy information seekers were also significantly more likely than light users to search the internet for all other health information, such as a specific disease and treatment and medical facilities. The heavy Web-based information seekers were more likely to be younger, female, highly educated, chronic disease patients, caregivers, and frequent internet users in general than the light Web-based information seekers.

Conclusions

To effectively communicate with their consumers, providers who target Web-based LTC information seekers can more carefully align their informational offerings with the specific needs of each subsegment of LTC markets.

The determinants of access to information on the Internet and knowledge of health related topics in European countries

The aim of this study is to analyze the determinants of access to health-related information on the Internet and their influence on perceived knowledge of health-related topics in European countries. Referring to the European citizens' digital health literacy survey and applying structural equation modelling hypotheses, the obtained results showed that assumption of acceptance of information and capacity level are the main determinants which have the biggest influence on the perception of access to health-related information on the Internet. The access to health-related information negatively determined the perceived level of knowledge about health-related topics, which reveals that people making more use of the information are more critical in assessing the level of their knowledge. People who evaluated their health status as poor stated that they knew about health-related topics less. Therefore, the high level of access to health-related information does not mean that people would assume having more knowledge about health-related topics. The establishment of a platform on the Internet, which would supply all understandable information on health-related topics, would be the main tool for enhancing the level of knowledge of health-related topics.

The ability to obtain, appraise and understand health information among undergraduate nursing students in a medical university in Chongqing, China

AIM

The aim of this study was to survey the ability of nursing students to obtain, appraise and understand health information and its influencing factors among undergraduate nursing students in a medical university in Chongqing, China.

DESIGN

A cross-sectional survey.

METHOD

The sample was obtained using stratified sampling methods. We used the internationally validated Health Literacy Questionnaire. Six hundred and fifteen (76.88%) of 800 nursing students completed participated anonymous questionnaires that measured their ability to obtain, appraise and understand health information.

RESULTS

Mean scores of nursing students to obtain, appraise and understand health information were 17.13, 13.07 and 17.78 respectively. Academic level, parental educational level and socioeconomic status were significantly associated with scores in obtaining, appraising and understanding health information.

The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points

BACKGROUND

The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known.

OBJECTIVE

This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions.

METHODS

The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested.

RESULTS

A total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times.

CONCLUSIONS

The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions.

Electronic Health Use in the European Union and the Effect of Multimorbidity: Cross-Sectional Survey

Background

Multimorbidity is becoming increasingly common and is a leading challenge currently faced by societies with aging populations. The presence of multimorbidity requires patients to coordinate, understand, and use the information obtained from different health care professionals, while simultaneously striving to distinguish the symptoms of different diseases and self-manage their sometimes conflicting health problems. Electronic health (eHealth) tools provide a means to disseminate health information and education for both patients and health professionals and hold promise for more efficient and cost-effective care processes.

Objective

The aim of this study was to analyze the use of eHealth tools, taking into account the citizens’ sociodemographic and clinical characteristics, and above all, the presence of multimorbidity.

Methods

Cross-sectional and exploratory research was conducted using online survey data from July 2011 to August 2011. Participants included a total of 14,000 citizens from 14 European countries aged 16 to 74 years, who had used an eHealth tool in the past 3 months. The variables studied were sociodemographic variables of the participants, the questionnaire items assessing the frequency of using eHealth tools, the degree of morbidity, and the eHealth adoption gradient. Chi-square tests were conducted to examine the relationship between the sociodemographic and clinical variables of participants and the group the participants were assigned to according to their frequency of eHealth use (eHealth user group). A one-way analysis of variance (ANOVA) allowed for assessing the differences in the eHealth adoption gradient average between different groups of individuals according to their morbidity level. A two-way between-groups ANOVA was performed to explore the effects of multimorbidity and age group on the eHealth adoption gradient.

Results

According to the eHealth adoption gradient, most participants (68.15%, 9541/14,000) were labeled as rare users, with the majority of them (55.1%, 508/921) being in the age range of 25 to 54 years, with upper secondary education (50.3%, 464/921), currently employed (49.3%, 454/921), and living in medium-sized cities (40.7%, 375/921). Results of the one-way ANOVA showed that the number of health problems significantly affected the use of eHealth tools (F_2,13996=11.584; P<.001). The two-way ANOVA demonstrated that there was a statistically significant interaction between the effects of age and number of health problems on the eHealth adoption gradient (F_4,11991=7.936; P<.001).

Conclusions

The eHealth adoption gradient has proven to be a reliable way to measure different aspects of eHealth use. Multimorbidity is associated with a more intense use of eHealth, with younger Internet users using new technologies for health purposes more frequently than older groups with the same level of morbidity. These findings suggest the need to consider different strategies aimed at making eHealth tools more sensitive to the characteristics of older populations to reduce digital disadvantages.

Characterization of Patient Interest in Provider-Based Consumer Health Information Technology: Survey Study

BACKGROUND

Consumer health information technology can improve patient engagement in their health care and assist in navigating the complexities of health care delivery. However, the consumer health information technology offerings of health systems are often driven by provider rather than patient perspectives and inadequately address patient needs, thus limiting their adoption by patients. Consideration given to patients as stakeholders in the development of such technologies may improve adoption, efficacy, and consumer health information technology resource allocation.

OBJECTIVE

The aims of this paper were to measure patient interest in different health system consumer health information technology apps and determine the influence of patient characteristics on consumer health information technology interest.

METHODS

Patients seen at the Cleveland Clinic Neurological Institute were electronically surveyed on their interest in using different consumer health information technology apps. A self-efficacy scale, Patient Health Questionnaire-9 depression screen, and EuroQol 5 dimensions health-related quality of life scale were also completed by patients. Logistic regression was used to determine the influence of patient characteristics on interest in consumer health information technology in the categories of self-management, education, and communication.

RESULTS

The majority of 3852 patient respondents had an interest in all technology categories assessed in the survey. The highest interest was in apps that allow patients to ask questions of providers (3476/3852, 90.24%) and to schedule appointments (3211/3839, 83.64%). Patient interest in consumer health information technology was significantly associated with greater depression symptoms, worse quality of life, greater health self-efficacy, and smartphone ownership (P<.001 for all listed).

CONCLUSIONS

Patients should be viewed as active stakeholders in consumer health information technology development and their perspectives should consistently guide development efforts. Health systems should consider focusing on consumer health information technologies that assist patients in scheduling appointments and asking questions of providers. Patients with depression should also be considered for targeted consumer health information technology implementation. Health self-efficacy is a valid predictor of consumer health information technology interest and may play a role in the utilization of consumer health information technologies. Health systems, broadly, should put forth greater effort to understand the needs and interests of patients in the consumer health information technology development process. Consumer health information technology design and implementation may be improved by understanding which technologies patients want.

Perspectives from the Patient and the Healthcare Professional in Multiple Sclerosis: Social Media and Patient Education

A diagnosis of multiple sclerosis (MS) is life-altering. Because the course of MS is heterogeneous, patients may face uncertainty in terms of long-term physical and cognitive challenges, potential loss of employment, and the risk of social isolation. Patients often turn to the Internet and social media for information about MS and its management, and to seek out fellow patients and support groups. Here, we examine the use of social media and the Internet among patients with MS, considering its impact on patient education. We consider the access that these conduits provide not only to other patients with MS but also to a wealth of disease-related information online. These themes are further illustrated with first-hand experiences of the patient author and her physician. We also explore the impact of the Internet and social media on the education and support of patients with MS from the healthcare professional’s (HCP’s) perspective, including opportunities for HCPs to promote disease education among their patients, and the advantages that arise from patients being better informed about their disease. The rise of the Internet and social media has changed the patient experience, helping patients to support each other, to educate themselves proactively about their condition, and to participate more actively in decisions relating to disease management than perhaps was the case historically.

Funding Novartis Pharmaceuticals Corporation.

Attitudes Toward e-Health: The Otolaryngologists' Point of View

INTRODUCTION

Online communication and the number of e-health applications have noticeably increased. However, little is known about the otolaryngologists' use behavior and their attitudes toward the potential of e-health. The aims of the study were to evaluate the documentation, information, and communication technologies used by otolaryngologists and to get a better understanding of their attitudes toward the potential of e-health for cross-sectoral patient care.

METHODS

A survey was developed and tested by otolaryngologists, healthcare-information technology experts, and health services researchers. A total of 334 otolaryngologists in private practice were asked to participate in this cross-sectional study. In total, 234 of them took part in the study, and 157 returned completed questionnaires. Statistical analysis was performed by using crosstabs, including chi-square tests, and multivariate logistic regressions. Results and Materials: Digital technologies are widely used by otolaryngologists (e.g., 89.6% use an electronic health record). However, the majority of intersectoral communication is still based on analogue techniques (e.g., fax use in 63.7%). From the otolaryngologists' perspectives, the potential of e-health for intersectoral care is mostly in appointment scheduling, further referrals to hospitals, and automated appointment reminders. The physicians' attitudes toward e-health are associated with their Internet use behavior in daily life (odds ratio = 4.30, confidence interval 1.11-16.64, p = 0.035) but not with their demographics.

DISCUSSION

The otolaryngologists are well prepared and have an overall positive attitude toward e-health for deeper use in cross-sectoral care. Therefore, e-health in otolaryngology needs more attention and resources for further studies, especially with a focus on quality and safety of care.

Effects of an interactive mHealth innovation for early detection of patient-reported symptom distress with focus on participatory care: protocol for a study based on prospective, randomised, controlled trials in patients with prostate and breast cancer

Background

Cancer patients are predominantly treated as out-patients and as they often experience difficult symptoms and side effects it is important to facilitate and improve patient-clinician communication to support symptom management and self-care. Although the number of projects within supportive cancer care evaluating mobile health is increasing, few evidence-based interventions are described in the literature and thus there is a need for good quality clinical studies with a randomised design and sufficient power to guide future implementations. An interactive information and communications technology platform, including a smartphone/computer tablet app for reporting symptoms during cancer treatment was created in collaboration with a company specialising in health care management. The aim of this paper is to evaluate the effects of using the platform for patients with breast cancer during neo adjuvant chemotherapy treatment and patients with locally advanced prostate cancer during curative radiotherapy treatment. The main hypothesis is that the use of the platform will improve clinical management, reduce costs, and promote safe and participatory care.

Method

The study is a prospective, randomised, controlled trial for each patient group and it is based on repeated measurements. Patients are consecutively included and randomised. The intervention groups report symptoms via the app daily, during treatment and up to three weeks after end of treatment, as a complement to standard care. Patients in the control groups receive standard care alone. Outcomes targeted are symptom burden, quality of life, health literacy (capacity to understand and communicate health needs and promote healthy behaviours), disease progress and health care costs. Data will be collected before and after treatment by questionnaires, registers, medical records and biomarkers. Lastly, participants will be interviewed about participatory and meaningful care.

Discussion

Results will generate knowledge to enhance understanding about how to develop person-centred care using mobile technology. Supporting patients’ involvement in their care to identify problems early, promotes more timely initiation of necessary treatment. This can benefit patients treated outside the hospital setting in regard to maintaining their safety.

Clinical trial registration

June 12 2015 NCT02477137 (Prostate cancer) and June 12 2015 NCT02479607 (Breast cancer).

Toward a Better Understanding of Patient Health Literacy: A Focus on the Skills Patients Need to Find Health Information

While many health literacy assessments exist, this area of research lacks an instrument that isolates and reflects the four components driving this concept (abilities to find, understand, use, and communicate about health information). The purpose of this study was to determine what abilities comprise the first component, how a patient finds health information. Low ( n = 13) and adequate ( n = 14) health literacy patients, and health professionals ( n = 10) described their experiences when looking for health information and the skills they employed to complete these tasks. Major skills/themes elicited included knowing when to search, credibility assessments, finding text and numerical information, interpersonal seeking, technology and online search, and spatial navigation. Findings from this study suggest that each of the dimensions included in the definition of health literacy warrants specific attention and assessment. Given identification of the skills comprising each dimension, interventions targeting deficits across health literacy dimensions could be developed to improve patient health.

Consumer-led health-related online sources and their impact on consumers: An integrative review of the literature

The aim of the review was to describe consumer-led health-related online sources and their impact on consumers. The review was carried out as an integrative literature review. Quantisation and qualitative content analysis were used as the analysis method. The most common method used by the included studies was qualitative content analysis. This review identified the consumer-led health-related online sources used between 2009 and 2016 as health-related online communities, health-related social networking sites and health-related rating websites. These sources had an impact on peer support; empowerment; health literacy; physical, mental and emotional wellbeing; illness management; and relationships between healthcare organisations and consumers. The knowledge of the existence of the health-related online sources provides healthcare organisations with an opportunity to listen to their consumers' 'voice'. The sources make healthcare consumers more competent actors in relation to healthcare, and the knowledge of them is a valuable resource for healthcare organisations. Additionally, these health-related online sources might create an opportunity to reduce the need for drifting among the healthcare services. Healthcare policymakers and organisations could benefit from having a strategy of increasing their health-related online sources.

Sexual Orientation and Health Information Technology Use: A Nationally Representative Study of U.S. Adults

PURPOSE

The purpose of this study was to compare the prevalence and odds of participation in online health-related activities among lesbian, gay, and bisexual adults and straight adults aged 18-64.

METHODS

Primary data collected in the 2013 and 2014 National Health Interview Survey, a nationally representative household health survey, were used to examine associations between sexual orientation and four measures of health information technology (HIT) use. Data were collected through face-to-face interviews (some telephone follow-up) with 54,878 adults aged 18-64.

RESULTS

Compared with straight men, both gay and bisexual men had higher odds of using computers to schedule appointments with healthcare providers, and using email to communicate with healthcare providers. Gay men also had significantly higher odds of seeking health information or participating in a health-related chat group on the Internet, and using computers to fill a prescription. No significant associations were observed between sexual orientation and HIT use among women in the multivariate analysis.

CONCLUSIONS

Gay and bisexual men make greater use of HIT than their straight counterparts. Additional research is needed to determine the causal factors behind these group differences in the use of online healthcare, as well as the health implications for each group.

Education-Based Gaps in eHealth: A Weighted Logistic Regression Approach

BACKGROUND

Persons with a college degree are more likely to engage in eHealth behaviors than persons without a college degree, compounding the health disadvantages of undereducated groups in the United States. However, the extent to which quality of recent eHealth experience reduces the education-based eHealth gap is unexplored.

OBJECTIVE

The goal of this study was to examine how eHealth information search experience moderates the relationship between college education and eHealth behaviors.

METHODS

Based on a nationally representative sample of adults who reported using the Internet to conduct the most recent health information search (n=1458), I evaluated eHealth search experience in relation to the likelihood of engaging in different eHealth behaviors. I examined whether Internet health information search experience reduces the eHealth behavior gaps among college-educated and noncollege-educated adults. Weighted logistic regression models were used to estimate the probability of different eHealth behaviors.

RESULTS

College education was significantly positively related to the likelihood of 4 eHealth behaviors. In general, eHealth search experience was negatively associated with health care behaviors, health information-seeking behaviors, and user-generated or content sharing behaviors after accounting for other covariates. Whereas Internet health information search experience has narrowed the education gap in terms of likelihood of using email or Internet to communicate with a doctor or health care provider and likelihood of using a website to manage diet, weight, or health, it has widened the education gap in the instances of searching for health information for oneself, searching for health information for someone else, and downloading health information on a mobile device.

CONCLUSION

The relationship between college education and eHealth behaviors is moderated by Internet health information search experience in different ways depending on the type of eHealth behavior. After controlling for college education, it was found that persons who experienced more fruitful Internet health information searches are generally less likely to engage in eHealth behaviors.

Patients retrieving additional information via the Internet: A trend analysis in a Swedish population, 2000—05

Aims: To examine the trends over five years for patients' seeking online additional health information about their disease/ health problem to what the doctor has been giving, and investigate any differences in information-seeking behaviour according to age, gender, self-perceived health status, living area, and type of medical encounter. Methods: Data from three independent surveys conducted in 2000, 2002, and 2005 of a population with a recent experience of outpatient care[n]typesetter: please remove blue shading here and elsewhere[/n], including 24,800 respondents aged between 20 and 95, were analysed in a trend analysis and a logistic regression regarding background factors that may influence the seeking behaviour. Results: During the study period, there was a significant increase in Internet use in most age groups. The total use among men 20—95 years old increased from 7% in 2000 to 18% in 2005 and from 9% to 25% for women respectively. The predictors for using the Internet as a source of information were: age, gender, self-perceived health status, living area, and the type of medical encounter (first or repeated). In 2005, women aged 20—49 used the Internet as a source to a significantly greater extent than men, even when all background factors were controlled for (OR 1.46 and CI 1.21—1.77). Conclusions: Swedish patients, especially the young and middle-aged, are to a substantial degree using the Internet to gather additional information on their disease. The benefits of this increase include more informed patients; however, there are inherent quality issues that require strategies for ensuring public access to high-quality health information online.

Indirect effects of contextual factors on patients' consultations with healthcare professionals about health information found online

Background

E-health users are encouraged to consult healthcare professionals about the health information they found online because it facilitates e-health users to participate in an informed decision-making process with healthcare professionals on treatment options. However, few studies have examined the path of how e-health users consult healthcare professionals about the health information. Using psychological empowerment, which claims that empowering individuals requires understanding contextual factors that interact with the individuals’ intrapsychic factors, this study tested a hypothesis: the contextual factors play an indirect role between patients’ perceived poor health and their consultations with healthcare professionals about the health information found online, holding predisposing factors constant.

Methods

The data were collected from the Health Information National Trends Survey and used a subsample of e-health users who used healthcare services during the past year. The subsample (N = 2,297) was analyzed using structural equation modeling (SEM).

Results

The SEM analysis supported the hypothesized indirect model. Meanwhile, patients with low socioeconomic statuses tended to score high in the outcome measurement of the contextual factors; however, they tended not to consult professionals.

Conclusions

It is important to acknowledge contextual factors, which encompass communication and relational aspects as well as the process and outcomes of treatments, when empowering e-health users to use e-health tools meaningfully and become empowered in caring for their own health. Particularly, those with low income and education levels were the less powered or powerless patients: they tended not to be competent in having a voice and discussing the health information that they found online with professionals.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1713-y) contains supplementary material, which is available to authorized users.

Informed Patients and the Internet

This article investigates how individuals’ use of the Internet for finding health information may affect the relationship between health professionals and patients. It explores people's rationales for searching for information online, the information selection process and the implications for doctor–patient interactions. Qualitative interviews were conducted by email with 31 health information seekers. Study findings show the importance of the ‘everyday’ in orientating health information searches and of personal experience in navigating a multiplicity of online sources. Interviewees emphasize the primary role of the doctor–patient relationship for delivering health and medical information, their Internet searches complementing rather than opposing professional expertise.

Examining the Correlates of Online Health Information-Seeking Behavior Among Men Compared With Women

This study aimed to identify and compare the demographic, health behavior, health status, and social media use correlates of online health-seeking behaviors among men and women. Cross-sectional self-report data were collected from 1,289 Australian adults participating in the Queensland Social Survey. Logistic regression analyses were used to identify the correlates of online health information seeking for men and women. Differences in the strength of the relation of these correlates were tested using equality of regression coefficient tests. For both genders, the two strongest correlates were social media use (men: odds ratio [ OR] = 2.57, 95% confidence interval [CI: 1.78, 3.71]; women: OR = 2.93, 95% CI [1.92, 4.45]) and having a university education (men: OR = 3.63, 95% CI [2.37, 5.56]; women: OR = 2.74, 95% CI [1.66, 4.51]). Not being a smoker and being of younger age were also associated with online health information seeking for both men and women. Reporting poor health and the presence of two chronic diseases were positively associated with online health seeking for women only. Correlates of help seeking online among men and women were generally similar, with exception of health status. Results suggest that similar groups of men and women are likely to access health information online for primary prevention purposes, and additionally that women experiencing poor health are more likely to seek health information online than women who are relatively well. These findings are useful for analyzing the potential reach of online health initiatives targeting both men and women.

Predictors of Online Cancer Prevention Information Seeking Among Patients and Caregivers Across the Digital Divide: A Cross-Sectional, Correlational Study

Background

The digital divide is a recognized public health problem caused by social determinants that exacerbate health disparities. Despite the “tectonic shift” in how most of the public obtains cancer information, underserved communities are at increased risk of being digitally marginalized. However, research that examines factors underlying eHealth information seeking in diverse health contexts is lacking.

Objective

The aim of this paper is to explore preferences and use of eHealth cancer prevention information (CPI) among patients and caregivers attending a minority-serving oncology clinic using the comprehensive model of information seeking as a theoretical framework. Specifically, the study examined the role of social determinants and prevention orientation in differences in preference and use of the Internet for CPI seeking among this diverse sample.

Methods

Survey methodology was used to identify social determinants and behavioral factors, including prevention orientation as correlates and predictors of respondents’ (n=252) preferences and use of eHealth for CPI seeking.

Results

Less than half (112/252, 44.4%) of respondents said that if faced with the need to seek CPI, they would seek this information online. In the final logistic regression model, education, ethnicity, age, and prevention orientation made significant contributions to the model (P<.05). Specifically, for each year increase in age, participants were 3% less likely to use the Internet for CPI seeking (P=.011). Compared to college graduates, respondents who did not complete high school were 11.75 times less likely to cite the Internet as a CPI carrier (P<.001) and those with a high school education were 3 times (2.99, P=.015) less likely. In addition, the odds that a Spanish speaker would cite the Internet as a CPI carrier were one-fifth (22%) of non-Hispanic whites (P=.032) and about one-quarter (26%) of English-speaking Latinos (P=.036). Finally, with each one point increase on the prevention orientation scale, respondents were 1.83 times less likely to cite online CPI seeking (P=.05).

Conclusions

Social determinants to health have profound influence on eHealth CPI seeking. Providers and policy makers should focus on meeting patients and family members’ CPI needs following diagnosis and increase eHealth accessibility and availability of evidence-based CPI to diverse populations. Future research is needed to unravel further differences in eHealth CPI seeking, including those among Native Americans that emerged as an additional digitally underserved racial/ethnic group. Finally, additional factors underlying these differences should be explored to better tailor CPI eHealth information to diverse communities’ information needs.

Examining Associations between Health Information Seeking Behavior and Adult Education Status in the U.S.: An Analysis of the 2012 PIAAC Data

This paper presents data from the Program for the International Assessment of Adult Competencies with a focus on the interrelationships among health information seeking behavior (HISB), and health status or use of preventive health measures for U.S. adults both with and without a high school diploma. Key results of ordinal and binary logistic regression analyses indicated that, after controlling for demographic factors, (1) adults with a high school diploma use more text-based health information sources while adults without a high school diploma use more oral sources, (2) using the Internet as a source of health information is more strongly related to reporting excellent/very good health status than having a high school diploma, (3) those without a high school diploma who use the Internet report the largest increase in health status over any other health information source, and (4) for those with learning disability or vision problem, a high facility in reading English is an important predictor of whether the Internet is used as a health information source. The Internet appears to play a key role in both enhancing health status and enabling use of preventive measures for those with and without a high school diploma; although, individuals without a high school diploma who use the Internet for health information derive substantial benefit in health status.

Internet Services for Communicating With the General Practice: Barely Noticed and Used by Patients

Background

The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients’ actual use and intention toward using.

Objective

The objective of the study is to investigate the actual use and intention toward using Internet services to communicate with the general practice by the general practice population. The secondary objective is to study the factors and characteristics that influence their intention to use such services.

Methods

There were 1500 members of the Dutch Health Care Consumer Panel, age over 18 years, that were invited to participate in this cross-sectional study. People who had contacted their general practitioner at least once in the past year were included. Participants were asked to fill out a questionnaire about the following services: Internet appointment planning, asking questions on the Internet, email reminders about appointments, Internet prescription refill requests, Internet access to medical data, and Internet video consultation. Participants indicated whether they had used these services in the past year, they would like to use them, and whether they thought their general practice had these services. For the first two services, participants rated items based on the unified theory of acceptance and use of technology complemented with additional constructs. These items were divided into six subscales: effort expectancy, performance expectancy, trust, attitude, facilitating conditions, and social influence.

Results

There were 546 participants that were included in the analyses out of 593 who met the inclusion criteria. The participants had a mean age of 53 years (SD 15.4), 43.6% (n=238) were male, and 66.8% (n=365) had at least one chronic illness. Actual use of the services varied between 0% (n=0, video consultation) and 10.4% (n=57, requesting prescription refill by Internet). The proportion of participants with a positive intention to use the service varied between 14.7% (n=80, video consultation) and 48.7% (n=266, Internet access to medical data). For each service, approximately half indicated that they did not know whether the service was available. Univariate logistic regression analyses revealed that all the constructs as well as age, level of education, and Internet usage had a significant association with intention toward using Internet appointment planning and asking questions by Internet.

Conclusions

Internet communication services to contact the general practice are not yet frequently used by this population. Although a substantial number of persons have a positive intention toward using such services, not all people who receive primary care seem willing to use them. The lack of awareness of the availability and functionality of such services might play an important role.

Predictors of online health information seeking behavior: Changes between 2002 and 2012

The Internet has become an important and preferred source of health information. Although the literature has highlighted several key predictors that influence an individual's online health information seeking behavior, insufficient attention has been paid to the changes in the predictors' roles and effects over time. This study explores and compares the effects that specific predictors had on online health information seeking behavior over a period of 10 years by integrating and analyzing two Pew datasets collected in 2002 and 2012. Hierarchical regression analyses indicate that socio-demographic factors and overall health condition are significant predictors that had an increasing impact on online health information seeking behavior. However, the impact of Internet usage decreased significantly from 2002 to 2012. A comparison across time contributes to a vertical understanding of the changes in online health information seeking behavior and its predictors and helps health professionals and researchers tailor their informational interventions to meet the up-to-date needs and preferences of users.