Impact of Social Processes in Online Health Communities on Patient Empowerment in Relationship With the Physician: Emergence of Functional and Dysfunctional Empowerment

The Role of Technology in Online Health Communities: A Study of Information-Seeking Behavior

This study significantly contributes to both theory and practice by providing valuable insights into the role and value of healthcare in the context of online health communities. This study highlights the increasing dependence of patients and their families on online sources for health information and the potential of technology to support individuals with health information needs. This study develops a theoretical framework by analyzing data from a cross-sectional survey using partial least squares structural equation modeling and multi-group and importance-performance map analysis. The findings of this study identify the most beneficial technology-related issues, like ease of site navigation and interaction with other online members, which have important implications for the development and management of online health communities. Healthcare professionals can also use this information to disseminate relevant information to those with chronic illnesses effectively. This study recommends proactive engagement between forum admins and participants to improve technology use and interaction, highlighting the benefits of guidelines for effective technology use to enhance users' information-seeking processes. Overall, this study's significant contribution lies in its identification of factors that aid online health community participants in the information-seeking process, providing valuable information to professionals on using technology to disseminate information relevant to chronic illnesses like COPD.

"We the BE": An educational mobile health application for children and families affected by bladder exstrophy-epispadias-cloacal exstrophy complex

GOALS

Despite the proliferation of over 45 000 smartphone mobile health applications (MHAs), as far as we know, there is no MHA for those living with rare diseases such as Bladder Exstrophy-Epispadias-Cloacal Exstrophy complex (BEEC). We hypothesized that an MHA could provide similar "on-demand" information and connectivity within health communities for patients with BEEC as they do for more common diseases. Thus, our primary goal was to create an MHA for patients and families affected by BEEC to provide them with important information about the condition and a format for them to connect with other affected patients and families. A secondary goal was to develop an adaptable MHA template for other rare diseases in the future.

METHODS

We began our app development by examining existing common-disease MHAs for thematic structure. We conducted an extensive literature search of PubMed and Google scholar for MHA development and existing MHAs related to BEEC, utilizing these search terms: mobile health applications, rare diseases, bladder exstrophy, and online health communities. Our app development team began with our clinical multidisciplinary team of pediatric urologists; a child psychiatrist; a patient/family mental health therapist; and a certified nurse practitioner. We hired a website engineer and a production team. All clinical members have extensive experience caring for children and families affected by BEEC. Additionally, clinical team members compiled lists of themes deemed relevant from these reviews and themes gleaned from their clinical experience that appear with some frequency or urgency and from the myriad of themes discussed within the literature for MHAs.

RESULTS

We found no existing rare disease MHAs in the literature or our search of app stores online. However, we derived basic app categories from existing MHA formats and the thematic content of all sources reviewed. These categories aligned with the groupings of our lists of clinical themes. Thus, we could subsume diverse themes within a broad categorical format: for example, child development (as "Psychological Development" in the app) or various clinical care options (as "Treatment"). This app structure became nine sections, as shown in. This format allows diverse information to be retrieved efficiently from broader categories. This app is being offered to affected families, healthcare providers, and individuals unrelated to where care is offered.

CONCLUSION

"We the BE" is the first MHA developed for a rare disease, BEEC. It has been published in a downloadable format for the general public at no cost. Further research is required to determine its efficacy for the BEEC community members; preliminary, unsolicited feedback from multiple users has been positive.

The quality of informational social support in online health communities: A content analysis of cancer-related discussions

Objective

Informational social support is one of the main reasons for patients to visit online health communities (OHCs). Calls have been made to investigate the objective quality of such support in the light of a worrying number of inaccurate online health-related information. The main aim of this study is to conceptualize the Quality of Informational Social Support (QISS) and develop and test a measure of QISS for content analysis. A further aim is to investigate the level of QISS in cancer-related messages in the largest OHC in Slovenia and examine the differences among various types of discussion forums, namely, online consultation forums, online support group forums, and socializing forums.

Methods

A multidimensional measurement instrument was developed, which included 20 items in a coding scheme for a content analysis of cancer-related messages. On a set of almost three million posts published between 2015 and 2019, a machine-learning algorithm was used to detect cancer-related discussions in the OHC. We then identified the messages providing informational social support, and through quantitative content analysis, three experts coded a random sample of 403 cancer-related messages for the QISS.

Results

The results demonstrate a good level of interrater reliability and agreement for a QISS scale with six dimensions, each demonstrating good internal consistency. The results reveal large differences among the social support, socializing, and consultation forums, with the latter recording significantly higher quality in terms of accuracy (M = 4.48, P < .001), trustworthiness (M = 4.65, P < .001), relevance (M = 3.59, P < .001), and justification (M = 3.81, P = .05) in messages providing informational social support regarding cancer-related issues.

Conclusions

This study provides the research field with a valid tool to further investigate the factors and consequences of varying quality of information exchanged in supportive communication. From a practical perspective, OHCs should dedicate more resources and develop mechanisms for the professional moderation of health-related topics in socializing forums and thereby suppress the publication and dissemination of low-quality information among OHC users and visitors.

How Do Team-Level and Individual-Level Linguistic Styles Affect Patients' Emotional Well-Being-Evidence from Online Doctor Teams

BACKGROUND

In the post-epidemic era, online medical care is developing rapidly, and online doctor teams are attracting attention as a high-quality online medical service model that can provide more social support for patients.

METHODS

Using online doctor teams on the Haodf.com platform as the research subject, this study investigates the key factors in the process of doctor-patient communication, which affects patients' emotional well-being. We also explore the different roles played by doctors as leaders and non-leaders in doctor-patient communication. From the perspective of language style, we select representative factors in the process of doctor-patient communication, namely the richness of health vocabulary, the expression of emotions, and the use of health-related terms (including perceptual words and biological words). We extract both team-level and individual-level linguistic communication styles through textual and sentiment analysis methods and empirically analyze their effects on patients' emotional well-being using multiple linear regression models.

RESULTS

The results show that the expression of positive emotions by the team and attention to patients' perceptions and biological conditions benefit patients' emotional well-being. Leaders should focus on the emotional expression, whereas non-leaders should focus on the use of perceptual and biological words.

CONCLUSIONS

This study expands the application of linguistic styles in the medical field and provides a practical basis for improving patients' emotional well-being.

Determining Factors Affecting the Users' Participation of Online Health Communities: An Integrated Framework of Social Capital and Social Support

As the national awareness of health keeps deepening, online health communities (OHCs) have achieved rapid development. Users' participation is critically important to the sustainable development of OHCs. Nevertheless, users usually lack the motive for participation. Based on the social capital theory, this research examines factors influencing users' participation in OHCs. The purpose of this research is to find out decisive factors that influence users' participation in OHCs, enrich the understanding of users' participation in OHCs, and help OHCs address the issue of sustainable development. The research model was empirically tested using 1277 responses from an online survey conducted in China. Data was analyzed using the structural equation modeling (SEM). We found informational support and emotional support to have significant direct effects over the structural capital, relational capital and cognitive capital of OHCs. Meanwhile, it is observed that relational capital and cognitive capital degree have a significant influence on knowledge acquisition and knowledge contribution of OHCs. For researchers this study provides a basis for further refinement of individual models of users' participation. For practitioners, understanding the social capital is crucial to users' knowledge acquisition and knowledge contribution that achieve high participation in OHCs.

Opportunities to expand access to mental health services: A case for the role of online peer support communities

This study investigated whether with disruptions in care due to the COVID-19 pandemic, persons who self-identified as living with a mental health condition increased their usage of an online peer support community. We also explored whether study participants who self-reported usage of online peer support communities were interested in using these communities to connect with evidence-based interventions and mental health services. This study employed a cross-sectional online survey design. The survey was disseminated by the Inspire online peer support community and Mental Health America through various social media channels. Descriptive and inferential analyses were conducted to summarize participant demographics, investigate patterns of use of online peer support communities, and interest in accessing additional programs through these platforms. There were 369 survey respondents, with a mean age of 49 (SD = 15.6), of which 77% were female. Most respondents self-reported having depression (34%), post-traumatic stress disorder (25%), and anxiety-related conditions (20%). The number of respondents who reported accessing online peer support platforms multiple times a day appeared to double after March 2020. We also found an overall positive association between frequency of community use and self-reported benefit to mental health. Approximately 81% of respondents expressed interest in accessing mental health services via an online peer support community. Persons who self-report living with mental health conditions and who engage in online peer support communities expressed interest in accessing evidence-based interventions via these online platforms. Participants were most interested in services related to enhancing coping mechanisms and skills, enabling overall wellbeing, and accessing therapy.

The Influence of Perceived Social Presence on the Willingness to Communicate in Mobile Medical Consultations: Experimental Study

BACKGROUND

With the rise of online health care service, there is growing discussion on the relationship between physicians and patients online, yet few researchers have paid attention to patients' perception of social presence, especially its influence on their willingness to communicate (WTC).

OBJECTIVE

The goal of the research is to investigate the influence of perceived social presence (PSP) on WTC in mobile medical consultations.

METHODS

Participants living in Yunnan province during the period of middle to high risk of COVID-19 infection were recruited via the internet. They were assigned randomly into 2 groups interacting with a virtual physician presenting high and low levels of social presence and then asked to complete a questionnaire. Based on the theoretical framework, the study puts forward a model evaluating the relationships among participants' PSP, communication apprehension (CA), self-perceived communication competence (SPCC), and willingness to communicate about health (WTCH) in the computer-mediated communication between virtual physicians and patients.

RESULTS

In total 206 (106 in group 1 and 100 in group 2) valid samples were gathered (from 276 log-ins) and 88.8% (183/206) of them were aged 18 to 44 years, which approximately resembles the age distribution of the main population engaging in online medical consultation in China. Independent t test shows that there is significant difference between the PSP of the 2 groups (P=.04), indicating a successful manipulation of social presence. The total effect of PSP on WTCH is 0.56 (P<.001), among which 74.4% is direct effect (P<.001). Among the indirect effects between PSP and WTCH, the mediating effect of SPCC accounts for 68.8% (P<.001) and the sequential mediating effect of CA→SPCC accounts for 19.2% (P<.001), while the mediating effect of CA alone is not significant (P=.08).

CONCLUSIONS

This study provides a comprehensible model, demonstrating that PSP is an important antecedent of WTCH, and the sequential mediating effect of CA and SPCC found in this study also proves that in the environment of online mobile medical services, CA cannot affect communication directly. The findings will provide some practical inspiration for the popularization of online medical service, especially for the promotion of online physician-patient communication.

Comparative Analysis of Social Support in Online Health Communities Using a Word Co-Occurrence Network Analysis Approach

Online health communities (OHCs) have become a major source of social support for people with health problems. Members of OHCs interact online with others facing similar health problems and receive multiple types of social support, including but not limited to informational support, emotional support, and companionship. The aim of this study is to examine the differences in social support communication among people with different types of cancers. A novel approach is developed to better understand the types of social support embedded in OHC posts. Our approach, based on the word co-occurrence network analysis, preserves the semantic structures of the texts. Information extraction from the semantic structures is supported by the interplay of quantitative and qualitative analyses of the network structures. Our analysis shows that significant differences in social support exist across cancer types, and evidence for the differences across diseases in terms of communication preferences and language use is also identified. Overall, this study can establish a new venue for extracting and analyzing information, so as to inform social support for clinical care.

Understanding Health Empowerment From the Perspective of Information Processing: Questionnaire Study

Background

Massive, easily accessible online health information empowers users to cope with health problems better. Most patients search for relevant online health information before seeing a doctor to alleviate information asymmetry. However, the mechanism of how online health information affects health empowerment is still unclear.

Objective

To study how online health information processing affects health empowerment.

Methods

We conducted a cross-sectional questionnaire study that included 343 samples from participants who had searched online health information before the consultation. Respondents' perceptions of online information cues, benefits, health literacy, and health empowerment were assessed.

Results

Perceived argument quality and perceived source credibility have significant and positive effects on perceived information benefits, but only perceived argument quality has a significant effect on perceived decision-making benefits. Two types of perceived benefits, in turn, affect health empowerment. The effects of perceived argument quality on perceived informational benefits and perceived decision-making benefits on health empowerment are significantly stronger for the high health literacy group than the low health literacy group (t₂₆₉=7.156, P<.001; t₂₆₉=23.240, P<.001). While, the effects of perceived source credibility on perceived informational benefits and perceived informational benefits on health empowerment are significantly weaker for the high health literacy group than the low health literacy group (t₂₆₉=–10.497, P<.001; t₂₆₉=–6.344, P<.001). The effect of perceived argument quality on perceived informational benefits shows no significant difference between high and low health literacy groups.

Conclusions

 In the context of online health information, perceived information benefits and perceived decision-making benefits are the antecedents of health empowerment, which in turn will be affected by perceived argument quality and perceived source credibility. Health literacy plays a moderating role in the relationship of some variables. To maximize health empowerment, online health information providers should strengthen information quality and provide differentiated information services based on users' health literacy.

Patient-Reported Outcomes in a Nationally Representative Sample of Older Internet Users: Cross-sectional Survey

BACKGROUND

The rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients' ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy.

OBJECTIVE

We explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes.

METHODS

Our study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age≥60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms.

RESULTS

Age (β=-.17; P=.02), gender (β=-.22; P=.01), and medical satisfaction (β=-.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender (β=.13; P=.05) and satisfaction with medical encounters (β=.34; P<.001) but negatively predicted by education (β=-.18; P=.03) and eHealth literacy (β=-.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education (β=-.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress (β=-.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress (β=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem (β=-.22; P=.01).

CONCLUSIONS

This study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals.

Mobile Health in Chronic Disease Management and Patient Empowerment: Exploratory Qualitative Investigation Into Patient-Physician Consultations

Background

Chronic diseases often present severe consequences for those affected. The management and treatment of chronic diseases largely depend on patients’ lifestyle choices and how they cope with the disease in their everyday lives. Accordingly, the ability of patients to self-manage diseases is a highly relevant topic. In relation to self-management, studies refer to patient empowerment as strengthening patients’ voices and enabling them to assert control over their health and treatment. Mobile health (mHealth) provides cost-efficient means to support self-management and foster empowerment.

Objective

There is a scarcity of research investigating how mHealth affects patient empowerment during patient-physician consultations. The objective of this study is to address this knowledge gap by investigating how mHealth affects consultations and patient empowerment.

Methods

We relied on data from an ethnographic field study of 6 children and adolescents diagnosed with juvenile idiopathic arthritis. We analyzed 6 patient-physician consultations and drew on Michel Foucault’s concepts of power and power technology.

Results

Our results suggest that the use of mHealth constitutes practices that structure the consultations around deviations and noncompliant patient behavior. Our analysis shows how mHealth is used to discipline patients and correct their behavior. We argue that the use of mHealth during consultations may unintentionally lead to relevant aspects of patients’ lives related to the disease being ignored; thus, inadvertently, patients’ voices may be silenced.

Conclusions

Our results show that concrete uses of mHealth may conflict with extant literature on empowerment, which emphasizes the importance of strengthening the patients’ voices and enabling patients to take more control of their health and treatment. We contribute to the state-of-the-art knowledge by showing that the use of mHealth may have unintended consequences that do not lead to empowerment. Our analysis underscores the need for further research to investigate how mHealth impacts patient empowerment during consultations.

Cognitive mechanisms underlying interaction and contribution in online health communities: the perspectives of doctors and patients

Purpose

Active interaction and knowledge contribution are vital yet challenging elements of the sustainable development of online health communities (OHCs). To investigate the cognitive mechanisms underlying these behaviours in doctors' and patients' use of OHCs, this study develops a theoretical model to examine the relationships among cognitive modes, patterns of interaction, perceived usefulness, and contribution behaviour and the impact of user identity on these relationships.

Design/methodology/approach

To test the research hypotheses, structural equation modelling and multiple-group analysis were used to analyse survey data from 207 doctors and 213 patients.

Findings

The results indicate that dual processes and perceived usefulness are the key cognitive antecedents of interaction and knowledge contribution, respectively. However, the correlation of the rational mode and instrumental interaction is significantly stronger in the doctors' group than in the patients' group, while a stronger correlation between the experiential mode and instrumental interaction is observed in the patients' group.

Practical implications

These findings support the development of information and system strategies to support the operation of dual processes underlying doctors' and patients' instrumental and affective interactions, facilitate evaluation and sense-making of interaction activities, and motivate knowledge contribution.

Originality/value

This study uncovers the invariance and variability in the relationships between salient cognitive activities and behavioural responses in doctors' and patients' use of OHCs and the impact of user identity on variability.

Seeking or contributing? Evidence of knowledge sharing behaviours in promoting patients' perceived value of online health communities

BACKGROUND

Health knowledge, as an important resource of online health communities (OHCs), attracts users to engage in OHCs and improve the traffics within OHCs, thereby promoting the development of OHCs. Seeking and contributing health knowledge are basic activities in OHCs and are helpful for users to solve their health-related problems, improve their health conditions and thus influence their evaluation of OHCs (ie perceived value of OHCs). However, how do patients' health knowledge seeking and health knowledge contributing behaviours together with other factors influence their perceived value of OHCs? We still have little knowledge.

OBJECTIVE

In order to address the above gap, we root the current study in social cognitive theory and prior related literature on health knowledge sharing in OHCs and patients' perceived value. We treat health knowledge seeking and health knowledge contributing behaviours as behavioural factors and structural social capital as an environmental factor and explore their impacts on patients' perceived value of OHCs.

DESIGN

We have built a theoretical model composed of five hypotheses. We have designed a questionnaire composed of four key constructs and then collected data via an online survey.

SETTING AND PARTICIPANTS

We have distributed the questionnaire in two Chinese OHCs. We obtained a sample of 352 valid responses that were completed by patients having a variety of conditions.

RESULTS

The empirical results indicate that health knowledge seeking and health knowledge contributing have positive impacts on patients' perceived value of OHCs. The impact of health knowledge seeking on patients' perceived value of OHCs is greater than the impact of health knowledge contributing. In addition, structural social capital moderates the effects of health knowledge seeking and health knowledge contributing on patients' perceived value of OHCs. It weakens the effect of health knowledge seeking but enhances the effect of health knowledge contributing on patients' perceived value of OHCs.

CONCLUSIONS

These findings contribute to the literature on patients' perceived value of OHCs and on the role of structural social capital in OHCs. For OHC managers, they should provide their users more opportunities to seek or contribute health knowledge in their communities.

Exploring eHealth Literacy and Patient-Reported Experiences With Outpatient Care in the Hungarian General Adult Population: Cross-Sectional Study

BACKGROUND

Digital health, which encompasses the use of information and communications technology in support of health, is a key driving force behind the cultural transformation of medicine toward people-centeredness. Thus, eHealth literacy, assisted by innovative digital health solutions, may support better experiences of care.

OBJECTIVE

The purpose of this study is to explore the relationship between eHealth literacy and patient-reported experience measures (PREMs) among users of outpatient care in Hungary.

METHODS

In early 2019, we conducted a cross-sectional survey on a large representative online sample recruited from the Hungarian general population. eHealth literacy was measured with the eHealth Literacy Scale (eHEALS). PREMs with outpatient care were measured with a set of questions recommended by the Organisation for Economic Co-operation and Development (OECD) for respondents who attended outpatient visit within 12 months preceding the survey. Bivariate relationships were explored via polychoric correlation, the Kruskal-Wallis test, and chi-square test. To capture nonlinear associations, after controlling covariates, we analyzed the relationship between eHEALS quartiles and PREMs using multivariate probit, ordinary least squares, ordered logit, and logistic regression models.

RESULTS

From 1000 survey respondents, 666 individuals (364 females, 54.7%) were included in the study with mean age of 48.9 (SD 17.6) years and mean eHEALS score of 29.3 (SD 4.9). Respondents with higher eHEALS scores were more likely to understand the health care professionals' (HCPs') explanations (χ29=24.2, P=.002) and to be involved in decision making about care and treatment (χ29=18.2, P=.03). In multivariate regression, respondents with lowest (first quartile) and moderately high (third quartile) eHEALS scores differed significantly, where the latter were more likely to have an overall positive experience (P=.02) and experience fewer problems (P=.02). In addition, those respondents had better experiences in terms of how easy it was to understand the HCPs' explanations (P<.001) and being able to ask questions during their last consultation (P=.04). Patient-reported experiences of individuals with highest (fourth quartile) and lowest (first quartile) eHEALS levels did not differ significantly in any items of the PREM instrument, and neither did composite PREM scores generated from the PREM items (P>.05 in all models).

CONCLUSIONS

We demonstrated the association between eHealth literacy and PREMs. The potential patient-, physician-, and system-related factors explaining the negative experiences among people with highest levels of eHealth literacy warrant further investigation, which may contribute to the development of efficient eHealth literacy interventions. Further research is needed to establish causal relationship between eHealth literacy and patient-reported experiences.

Exploring the Factors Influencing Consumers to Voluntarily Reward Free Health Service Contributors in Online Health Communities: Empirical Study

BACKGROUND

Rewarding health knowledge and health service contributors with money is one possible approach for the sustainable provision of health knowledge and health services in online health communities (OHCs); however, the reasons why consumers voluntarily reward free health knowledge and health service contributors are still underinvestigated.

OBJECTIVE

This study aimed to address the abovementioned gap by exploring the factors influencing consumers' voluntary rewarding behaviors (VRBs) toward contributors of free health services in OHCs.

METHODS

On the basis of prior studies and the cognitive-experiential self-theory (CEST), we incorporated two health service content-related variables (ie, informational support and emotional support) and two interpersonal factors (ie, social norm compliance and social interaction) and built a proposed model. We crawled a dataset from a Chinese OHC for mental health, coded it, extracted nine variables, and tested the model with a negative binomial model.

RESULTS

The data sample included 2148 health-related questions and 12,133 answers. The empirical results indicated that the effects of informational support (β=.168; P<.001), emotional support (β=.463; P<.001), social norm compliance (β=.510; P<.001), and social interaction (β=.281; P<.001) were significant. The moderating effects of social interaction on informational support (β=.032; P=.02) and emotional support (β=-.086; P<.001) were significant. The moderating effect of social interaction on social norm compliance (β=.014; P=.38) was insignificant.

CONCLUSIONS

Informational support, emotional support, social norm compliance, and social interaction positively influence consumers to voluntarily reward free online health service contributors. Social interaction enhances the effect of informational support but weakens the effect of emotional support. This study contributes to the literature on knowledge sharing in OHCs by exploring the factors influencing consumers' VRBs toward free online health service contributors and contributes to the CEST literature by verifying that the effects of experiential and rational systems on individual behaviors can vary while external factors change.

Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies

BACKGROUND

Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties.

OBJECTIVE

Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C).

METHODS

This study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions.

RESULTS

A total of 2 co-design workshops were held with 18 users-young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions-young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context.

CONCLUSIONS

The application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C-a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.

Collective Empowerment in Online Health Communities: Scale Development and Empirical Validation

Background

The role of online health communities (OHCs) in patient empowerment is growing and has been increasingly studied in recent years. Research has focused primarily on individualistic conception of patients’ empowerment, with much less attention paid to the role of OHCs in the development of patients’ collective empowerment. Although OHCs have immense potential for empowerment that goes beyond the individual, the concept and scale of collective empowerment in OHCs have not yet been developed or validated.

Objective

This study aimed to develop an instrument for measuring collective empowerment in online health communities (CE-OHC) and to test its quality by investigating its factorial structure, reliability, construct validity, and predictive validity.

Methods

The CE-OHC scale was developed according to a strict methodology for developing valid and reliable scales. An initial set of 20 items was first tested in the pilot study conducted in 2016 using a sample of 280 registered users of Slovenia’s largest OHC. A refined version with 11 items was tested in the main study conducted in 2018 on a random sample of 30,000 registered users of the same OHC. The final sample comprised 784 users. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate the factorial structure, discriminant validity, and convergent validity of the scale. Cronbach alpha coefficient was used to determine the CE-OHC scale’s internal consistency. To establish the predictive validity, ordinary least squares regression was performed to test the role of CE-OHC in users’ civic participation.

Results

The EFA resulted in a two-factor solution, and the two factors—knowledge of resources and resource mobilization for collective action—together explain 63.8% of the variance. The second-order CFA demonstrated a good fit to the data (root mean square error of approximation=0.07) and the scale had a good internal consistency (alpha=.86). Although evidence of the scale’s convergent validity was partially provided, discriminant validity of the scale remained unconfirmed. Overall, CE-OHC was confirmed to be a predictor of users’ civic participation, but the influence was somewhat weak and inconsistent across two subscales.

Conclusions

The proposed CE-OHC scale is a reliable and relatively valid instrument and serves as a good baseline to advance the measurement of collective empowerment in OHC contexts. This is the first scale developed for this purpose, and future research should focus on the development of a clear nomological network of the collective empowerment construct in relation to the OHC settings.

Effects of Three Antecedents of Patient Compliance for Users of Peer-to-Peer Online Health Communities: Cross-Sectional Study

Background

Over the past 50 years, patient noncompliance has appeared as a major public health concern and focus of a great deal of research because it endangers patient recovery and imposes a considerable financial burden on health care systems. Meanwhile, online health communities (OHCs) are becoming more common and are commonly used by individuals with health problems, and they may have a role in facilitating compliance. Despite this growing popularity, little is known about patient compliance predictors for OHCs’ users.

Objective

This study aimed to investigate the extent to which participating in OHCs may trigger higher levels of compliance. It identified 3 interrelated predictors that may affect patient compliance: patient empowerment gained through peer-to-peer OHCs, satisfaction with the physician, and commitment to the physician.

Methods

A Web-based survey tested the conceptual model and assessed the effects of patient empowerment gained through OHCs on patient satisfaction and commitment to the physician, as well as the effects of these 3 predictors on patient compliance with the proposed treatment. Members of peer-to-peer OHCs were asked to answer an online questionnaire. A convenience sample of 420 patients experiencing chronic illness and using peer-to-peer OHCs was surveyed in August 2018 in Québec, Canada. A path analysis using structural equation modeling tested the proposed relationships between the predictors and their respective paths on patient compliance. The mediation effects of these predictor variables on patient compliance were estimated with the PROCESS macro in SPSS.

Results

The findings indicated that patient empowerment gained through OHCs was positively related to patient commitment to the physician (beta=.69; P<.001) and patient compliance with the proposed treatment (beta=.35; P<.001). Patient commitment also positively influenced patient compliance (beta=.74; P<.001). Patient empowerment did not exert a significant influence on patient satisfaction with the physician (beta=.02; P=.76), and satisfaction did not affect compliance (beta=−.07; P=.05); however, patient satisfaction was positively related to patient commitment to the physician (beta=.14; P<.01). The impact of empowerment on compliance was partially mediated by commitment to the physician (beta=.32; 95% CI 0.22-0.44) but not by satisfaction.

Conclusions

This study highlights the importance of peer-to-peer OHCs for two main reasons. The primary reason is that patient empowerment gained through peer-to-peer OHCs both directly and indirectly enhances patient compliance with the proposed treatment. The underlying mechanisms of these effects were shown. Second, commitment to the physician was found to play a more critical role than satisfaction with the physician in determining patient-physician relationship quality. Overall, our findings support the assumption that health care stakeholders should encourage the use of peer-to-peer OHCs to favor patient empowerment and patient commitment to the physician to increase patient compliance with the proposed treatment.

Exploring patient empowerment

Purpose

The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process.

Design/methodology/approach

The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling.

Findings

This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment.

Research limitations/implications

The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment.

Practical implications

The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement.

Originality/value

The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.

The Antecedents and Consequences of Health Care Professional-Patient Online Interactions: Systematic Review

Background

Online health care services effectively supplement traditional medical treatment. The development of online health care services depends on sustained interactions between health care professionals (HCPs) and patients. Therefore, it is necessary to understand the demands and gains of health care stakeholders in HCP-patient online interactions and determine an agenda for future work.

Objective

This study aims to present a systematic review of the antecedents and consequences of HCP-patient online interactions. It seeks to reach a better understanding of why HCPs and patients are willing to interact with each other online and what the consequences of HCP-patient online interactions are for health care stakeholders. Based on this, we intend to identify the gaps in existing studies and make recommendations for future research.

Methods

In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic retrieval was carried out from the Web of Science, PubMed, and Scopus electronic databases. The search results were confined to those papers published in English between January 1, 2000 and June 30, 2018. Selected studies were then evaluated for quality; studies that did not meet quality criteria were excluded from further analysis. Findings of the reviewed studies related to our research questions were extracted and synthesized through inductive thematic analysis.

Results

A total of 8440 records were found after the initial search, 28 papers of which were selected for analysis. Accessibility to HCPs, self-management, and unmet needs were the main triggers for patients to participate in online interaction. For HCPs, patient education, career needs, and self-promotion were the major reasons why they took the online approach. There were several aspects of the consequences of HCP-patient online interactions on health care stakeholders. Consequences for patients included patient empowerment, health promotion, and acquisition of uncertain answers. Consequences for HCPs included social and economic returns, lack of control over their role, and gaining more appointments. HCP-patient online interactions also improved communication efficiency in offline settings and helped managers of online health care settings get a better understanding of patients’ needs. Health care stakeholders have also encountered ethical and legal issues during online interaction.

Conclusions

Through a systematic review, we sought out the antecedents and consequences of HCP-patient online interactions to understand the triggers for HCPs and patients to participate and the consequences of participating. Potential future research topics are the influences on the chain of online interaction, specifications and principles of privacy design within online health care settings, and roles that sociodemographic and psychological characteristics play. Longitudinal studies and the adoption of text-mining method are worth encouraging. This paper is expected to contribute to the sustained progress of online health care settings.

Impact of Physician-Patient Communication in Online Health Communities on Patient Compliance: Cross-Sectional Questionnaire Study

Background

In China, the utilization of medical resources is tense, and most hospitals are highly congested because of the large population and uneven distribution of medical resources. Online health communities (OHCs) play an important role in alleviating hospital congestions, thereby improving the utilization of medical resources and relieving medical resource shortages. OHCs have positive effects on physician-patient relationships and health outcomes. Moreover, as one of the main ways for patients to seek health-related information in OHCs, physician-patient communication may affect patient compliance in various ways. In consideration of the inevitable development of OHCs, although they have several shortcomings, identifying how physician-patient communication can impact patient compliance is important to improve patients’ health outcomes through OHCs.

Objective

This study aimed to investigate the impact of physician-patient communication on patient compliance in OHCs through the mediation of the perceived quality of internet health information, decision-making preference, and physician-patient concordance, using an empirical study based on the self-determination theory.

Methods

A research model was established, including 1 independent variable (physician-patient communication), 3 mediators (perceived quality of internet health information, decision-making preference, and physician-patient concordance), 1 dependent variable (patient compliance), and 4 control variables (age, gender, living area, and education level). Furthermore, a Web-based survey involving 423 valid responses was conducted in China to collect data, and structural equation modeling and partial least squares were adopted to analyze data and test the hypotheses.

Results

The questionnaire response rate was 79.2% (487/615) and the validity rate was 86.9% (423/487); reliability and validity are acceptable. The communication between physicians and patients in OHCs positively affects patient compliance through the mediation of the perceived quality of internet health information, decision-making preference, and physician-patient concordance. Moreover, physician-patient communication exhibits similar impacts on the perceived quality of internet health information, decision-making preference, and physician-patient concordance. Patients’ decision-making preference shows the weakest impact on patient compliance compared with the other 2 mediators. Ultimately, all 3 mediators play a partially mediating role between physician-patient communication and patient compliance.

Conclusions

We conclude that physician-patient communication in OHCs exhibits a positive impact on patient compliance; thus, patient compliance can be improved by guiding physician-patient communication in OHCs. Furthermore, our findings suggest that physicians can share high-quality health information with patients, discuss benefits, risks, and costs of treatment options with patients, encourage patients to express their attitudes and participate in health-related decision making, and strengthen the emotional connection with patients in OHCs, thereby decreasing patients’ misunderstanding of information and increasing concordance between physicians and patients. OHCs are required to not only strengthen the management of their published health information quality but also understand users’ actual attitudes toward information quality and then try to reduce the gap between the perceived and actual quality of information.

Patient Continued Use of Online Health Care Communities: Web Mining of Patient-Doctor Communication

BACKGROUND

In practice, online health communities have passed the adoption stage and reached the diffusion phase of development. In this phase, patients equipped with knowledge regarding the issues involved in health care are capable of switching between different communities to maximize their online health community activities. Online health communities employ doctors to answer patient questions, and high quality online health communities are more likely to be acknowledged by patients. Therefore, the factors that motivate patients to maintain ongoing relationships with online health communities must be addressed. However, this has received limited scholarly attention.

OBJECTIVE

The purpose of this study was to identify the factors that drive patients to continue their use of online health communities where doctor-patient communication occurs. This was achieved by integrating the information system success model with online health community features.

METHODS

A Web spider was used to download and extract data from one of the most authoritative Chinese online health communities in which communication occurs between doctors and patients. The time span analyzed in this study was from January 2017 to March 2017. A sample of 469 valid anonymous patients with 9667 posts was obtained (the equivalent of 469 respondents in survey research). A combination of Web mining and structural equation modeling was then conducted to test the research hypotheses.

RESULTS

The results show that the research framework for integrating the information system success model and online health community features contributes to our understanding of the factors that drive patients' relationships with online health communities. The primary findings are as follows: (1) perceived usefulness is found to be significantly determined by three exogenous variables (ie, social support, information quality, and service quality; R²=0.88). These variables explain 87.6% of the variance in perceived usefulness of online health communities; (2) similarly, patient satisfaction was found to be significantly determined by the three variables listed above (R²=0.69). These variables explain 69.3% of the variance seen in patient satisfaction; (3) continuance use (dependent variable) is significantly influenced by perceived usefulness and patient satisfaction (R²=0.93). That is, the combined effects of perceived usefulness and patient satisfaction explain 93.4% of the variance seen in continuance use; and (4) unexpectedly, individual literacy had no influence on perceived usefulness and satisfaction of patients using online health communities.

CONCLUSIONS

First, this study contributes to the existing literature on the continuance use of online health communities using an empirical approach. Second, an appropriate metric was developed to assess constructs related to the proposed research model. Additionally, a Web spider enabled us to acquire objective data relatively easily and frequently, thereby overcoming a major limitation of survey techniques.