How Experts' Use of Medical Technical Jargon in Different Types of Online Health Forums Affects Perceived Information Credibility: Randomized Experiment With Laypersons

Perceptions of primary care patients on the use of electronic clinical decision support tools to facilitate health care: A systematic review

OBJECTIVE

Electronic clinical decision support tools (eCDSTs) are interventions designed to facilitate clinical decision-making using targeted medical knowledge and patient information. While eCDSTs have been demonstrated to improve quality of care, there is a paucity of research relating to the acceptability of eCDSTs in primary care from the patients' perspective. This study aims to summarize current evidence relating to primary care patients' perceptions and experiences on the use of eCDSTs by their clinician to provide care.

METHODS

Four databases (Medline, Embase, CINAHL and Cochrane Library) were searched for qualitative and quantitative studies with outcomes relating to patients' perceptions of the use of clinician-facing or shared-eCDSTs. Data extraction and critical appraisal using the Johanna Briggs Institute Critical Appraisal checklists were carried out independently by reviewers. Qualitative and quantitative outcomes were synthesized independently. We used Richardson et al. 'Patient Evaluation of Artificial Intelligence (AI) in Healthcare' framework for qualitative analysis.

FINDINGS

20 papers were included for synthesis. eCDSTs were generally well-regarded by patients. The key facilitators for use were promoting informed decision-making, prompting discussions, aiding clinical decision-making, and enabling information sharing. Key barriers for use were lack of holistic care, 'medicalized' language, and confidentiality concerns.

CONCLUSION

Our study identified important aspects to consider in the development of future eCDSTs. Patients were generally positive regarding the use of eCDSTs; however, patient's perspectives should be included from the conception of new eCDSTs to ensure recommendations align with the needs of patients and clinicians.

PRACTICE IMPLICATIONS

The study results contribute to ensuring the acceptability of eCDSTs for patients and their unique needs. Encouragement is given for future development to adopt and build upon these findings. Additional research focusing on patients' perceptions of using eCDSTs for specific health conditions is deemed necessary.

How Does Physician (Non)accommodation Affect Patient Behavioral Intention? Using a Web-Based Experiment to Examine Indirect Effects of Language Type on Behavioral Intention Through Goal Inferences and Source Appraisals

Drawing on communication accommodation theory (CAT), we investigated how physician (non)accommodation indirectly affects participants' intention to engage in advocated health behaviors through participant goal inferences and source appraisals. We conducted a 3 (language type: medical jargon, analogies, literal language) × 2 (health topic: coronary artery disease, influenza vaccine) web-based experiment. Participants recruited from an online research panel (N = 545) were randomly assigned to a condition and watched a video featuring a physician explaining medical information and providing health recommendations. In a serial mediation analysis, results suggested two parallel indirect effects (relational vs. informational). Relative to underaccommodation (i.e. medical jargon), physician accommodation (i.e. literal language, analogies) had positive, indirect effects on participant health behavioral intention through goal inferences and assessment of physicians (i.e. warmth, expertise). Compared to the use of literal language, physician use of analogies had a positive, indirect effect on participant behavioral intention solely through the relational path, not the informational path. These findings extend CAT by explicating a mechanism underlying physician (non)accommodation and patient outcomes, offering practical implications for physicians to foster relationships with patients and facilitate patient comprehension.

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.

Do Open-Science Badges Increase Trust in Scientists Among Undergraduates, Scientists, and the Public?

In three experimental studies, we investigated whether badges for open-science practices have the potential to affect trust in scientists and topic-specific epistemic beliefs by student teachers (n = 270), social scientists (n = 250), or the public (n = 257), all of whom were at least 16 years old. Furthermore, we analyzed the moderating role of epistemic beliefs for badges and trust. Each participant was randomly assigned to two of three conditions: badges awarded, badges not awarded, and no badges (control). In all samples, our Bayesian analyses indicated that badges influence trust as expected, with one exception in the public sample: An additional positive effect of awarded badges (compared with no badges) was not supported. For students and scientists, we found evidence for the relation of badges and epistemic beliefs as well as epistemic beliefs and trust. Further, we found evidence for the absence of moderation by epistemic beliefs.

Language Use in Conversational Agent-Based Health Communication: Systematic Review

Background

Given the growing significance of conversational agents (CAs), researchers have conducted a plethora of relevant studies on various technology- and usability-oriented issues. However, few investigations focus on language use in CA-based health communication to examine its influence on the user perception of CAs and their role in delivering health care services.

Objective

This review aims to present the language use of CAs in health care to identify the achievements made and breakthroughs to be realized to inform researchers and more specifically CA designers.

Methods

This review was conducted by following the protocols of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. We first designed the search strategy according to the research aim and then performed the keyword searches in PubMed and ProQuest databases for retrieving relevant publications (n=179). Subsequently, 3 researchers screened and reviewed the publications independently to select studies meeting the predefined selection criteria. Finally, we synthesized and analyzed the eligible articles (N=11) through thematic synthesis.

Results

Among the 11 included publications, 6 deal exclusively with the language use of the CAs studied, and the remaining 5 are only partly related to this topic. The language use of the CAs in these studies can be roughly classified into six themes: (1) personal pronouns, (2) responses to health and lifestyle prompts, (3) strategic wording and rich linguistic resources, (4) a 3-staged conversation framework, (5) human-like well-manipulated conversations, and (6) symbols and images coupled with phrases. These derived themes effectively engaged users in health communication. Meanwhile, we identified substantial room for improvement based on the inconsistent responses of some CAs and their inability to present large volumes of information on safety-critical health and lifestyle prompts.

Conclusions

This is the first systematic review of language use in CA-based health communication. The results and limitations identified in the 11 included papers can give fresh insights into the design and development, popularization, and research of CA applications. This review can provide practical implications for incorporating positive language use into the design of health CAs and improving their effective language output in health communication. In this way, upgraded CAs will be more capable of handling various health problems particularly in the context of nationwide and even worldwide public health crises.

I am a scientist . . . Ask Me Anything: Examining differences between male and female scientists participating in a Reddit AMA session

This article investigates interactions between scientists and the online community Reddit. Given that past research on computer-mediated communication between scientists and the public found that male scientists are typically more popular in online spaces than female scientists, we examined differences in popularity as well as potential gendered differences in communication style. Specifically, we examined 269 Reddit "Ask Me Anything" sessions as well as the comments linked with each session (n = 125,580). Overall, we find that male scientists receive more comments on their sessions, but the score an individual comment receives does not differ by gender. Similarly, we find that the message complexity of the comments does not differ by gender. Taken together, these suggest that Reddit AMA sessions might be an effective platform for both male and female scientists to engage with the public.

"You Are Not Alone"-Opportunities and Challenges for University Students' Collaborative Engagement When Dealing With Online Information About COVID-19

In view of the COVID-19 pandemic, students had to cope with the challenging situation of handling a vast amount of potentially conflicting online information while staying informed. Reading conflicting scientific information has been shown to require cognitive effort for one to integrate it successfully, but reading such information during a crisis-such as the COVID-19 pandemic-may cause additional emotional stress, as students also had to cope with critical aspects of the pandemic (e.g., physical distancing and uncertainty). Different studies have indicated that in crises, stress can be relieved by seeking online social support (as a coping strategy). Similarly, working together (as collaborative learning) can also help people more critically discuss information on a cognitive level. Based on the approaches of online collaborative learning and online social support seeking, we were interested in whether an individual vs. collaborative communication setting would lead to any differences in students' cognitive as well as emotional engagement with conflicting information about COVID-19. In a 2 × 2 mixed design, N = 109 education science students were exposed to two conflicting texts regarding COVID-19 testing that contained current scientific information. The online experiment was conducted in Germany in April 2020, which was the beginning of lockdown in that country. After reading the two texts, participants were asked to reflect on their engagement with the conflicting information either individually (individual group, n = 49) or via chat collaboratively (collaboration group, n = 60 in 30 dyads). With respect to participants' written reflections (content-analyzed regarding cognitive as well as emotional engagement), participants in the collaborative group, compared to those in the individual group, more often discussed the pandemic in general and less often engaged emotionally when discussing the evidence from texts. All participants reported higher perceived information overload, lower self-efficacy in sourcing information about COVID-19, and higher active coping strategies after the reflection task compared to before reading the information, with no significant differences between the collaborative and individual groups. We discuss these findings regarding any opportunities and challenges that arise in online collaboration between students for cognitive and emotional engagement when handling conflicting information about COVID-19.

Exploring the factors in information seeking behavior: a perspective from multinational COPD online forums

This research establishes a theoretical framework for evaluating antecedents of the information seeking behaviors of online forum participants with chronic obstructive pulmonary disease (COPD). We evaluated the proposed framework using partial least squares structural equation modeling (PLS-SEM) after gathering data using a cross-sectional survey. We subsequently assessed the framework using importance-performance map analysis (IPMA). Findings suggest that perceived ease of use does not singularly influence COPD forum users' information seeking behavior. IPMA analysis reveals that the opportunity to interact with other forum members creates the greatest impact on COPD forum users' mindsets, among all the indicators. For healthcare professionals, the results of this study provide a blueprint in terms of utilizing COPD online forums to foster recurrent associations among forum administrators and users and by creating a strong social and informational resource for COPD information seekers.

"I FELT THE CONNECTION": A QUALITATIVE EXPLORATION OF STANDARDIZED PATIENTS' EXPERIENCES IN A DELIVERING BAD NEWS SCENARIO

Background

Little research has examined standardized patient experiences in stressful simulation scenarios.

Methods

Qualitative, secondary data analysis.

Results

Emergent themes included: "Those kinds of things are important": The incorporation of personal experiences enhances communication accommodation experiential learning; "She was trying to buffer the bad news": How SPs recognize and address problematic divergent behaviors; and "The emotions come up": Interactions with excellent communication accommodation behaviors can lead to SP emotional and physical distress.

Conclusion

Standardized patient expertise enhances scenario realism and communication skills evaluation. To minimize distress, simulation educators should tailor safety measures specifically for the individual standardized patient and the scenario.

The role of collaborative argumentation in future teachers' selection of online information

Abstract. (Future) teachers should acquire skills in sourcing science-related information online, so they can use evidence appropriately in their pedagogical practice. To successfully use such evidence, it is vital that teachers critically question their selection of online information. Based on findings from collaborative learning, we hypothesized that collaboration promotes teachers' critical elaboration of their selection of online educational information. Additionally, collaboration allows for social comparison and may thus impact teachers' self-efficacy in seeking information. In a 2 × 2 mixed-design study with the between-participants factor reasoning (individual vs. collaborative) and the within-participants factor self-reported information seeking self-efficacy (pre vs. post the reasoning task), each of N = 83 future teachers individually sought online information regarding the educational use of mobile phones in classrooms. This constituted a realistic search on the Internet, in a natural setting. Based on each participant's particular search, s/he was asked to select the online sources that s/he perceived relevant for reasoning whether mobile phones should be used in class. To foster reflection on how they selected information, participants were asked either to reason individually (individual group, n = 33) or to chat collaboratively (collaboration group, n = 50 in 25 dyads) about their selections. Participants in both groups reported higher information seeking self-efficacy after the reasoning task. Yet participants who collaboratively reflected on their selections more frequently showed elaborated reasoning behavior, than did participants in the individual group. Nonetheless, participants in both groups referred to certain criteria that guided their selection (i.e., criteria related to the information, the provider of information, or media) with the same frequency. Considering the potential benefits and challenges of collaboration, we discuss the findings in terms of how to promote future teachers' ability to critically reflect on their selection of online educational information.

Towards an Inclusive Museum Management Strategy. An Exploratory Study of Consumption Experience in Visitors with Disabilities. The Case of the CosmoCaixa Science Museum

In the field of cultural tourism, museums have been pioneers in focusing on visitors with disabilities. They have used inclusive orientation to offer the kind of memorable and satisfying experiences that are so beneficial to a group at constant risk of social exclusion. Their task is made more difficult, however, by visitors’ perception of barriers to inclusion, and identification therefore becomes a priority at the strategic level. Based on this idea, the present study analyzes experiences from two tours of the CosmoCaixa Barcelona museum by 32 people with disabilities (PwD). The use of ethnographic techniques and post-experience interviews shows how, despite the legal framework in relation to people with disabilities, hospitality managers find it difficult to put this framework into practice and cater to the needs of this segment of the population. Two factors become particularly clear: the difficulties experienced by museum staff in identifying people with disability, and museum managers’ lack of training and knowledge of the wants and needs of people with disabilities. Academic and strategic recommendations for museum managers are provided at the end of the article.

Constraints and Affordances of Online Engagement With Scientific Information-A Literature Review

Many urgent problems that societies currently face—from climate change to a global pandemic—require citizens to engage with scientific information as members of democratic societies as well as to solve problems in their personal lives. Most often, to solve their epistemic aims (aims directed at achieving knowledge and understanding) regarding such socio-scientific issues, individuals search for information online, where there exists a multitude of possibly relevant and highly interconnected sources of different perspectives, sometimes providing conflicting information. The paper provides a review of the literature aimed at identifying (a) constraints and affordances that scientific knowledge and the online information environment entail and (b) individuals' cognitive and motivational processes that have been found to hinder, or conversely, support practices of engagement (such as critical information evaluation or two-sided dialogue). Doing this, a conceptual framework for understanding and fostering what we call online engagement with scientific information is introduced, which is conceived as consisting of individual engagement (engaging on one's own in the search, selection, evaluation, and integration of information) and dialogic engagement (engaging in discourse with others to interpret, articulate and critically examine scientific information). In turn, this paper identifies individual and contextual conditions for individuals' goal-directed and effortful online engagement with scientific information.

Spelling Errors and Shouting Capitalization Lead to Additive Penalties to Trustworthiness of Online Health Information: Randomized Experiment With Laypersons

BACKGROUND

The written format and literacy competence of screen-based texts can interfere with the perceived trustworthiness of health information in online forums, independent of the semantic content. Unlike in professional content, the format in unmoderated forums can regularly hint at incivility, perceived as deliberate rudeness or casual disregard toward the reader, for example, through spelling errors and unnecessary emphatic capitalization of whole words (online shouting).

OBJECTIVE

This study aimed to quantify the comparative effects of spelling errors and inappropriate capitalization on ratings of trustworthiness independently of lay insight and to determine whether these changes act synergistically or additively on the ratings.

METHODS

In web-based experiments, 301 UK-recruited participants rated 36 randomized short stimulus excerpts (in the format of information from an unmoderated health forum about multiple sclerosis) for trustworthiness using a semantic differential slider. A total of 9 control excerpts were compared with matching error-containing excerpts. Each matching error-containing excerpt included 5 instances of misspelling, or 5 instances of inappropriate capitalization (shouting), or a combination of 5 misspelling plus 5 inappropriate capitalization errors. Data were analyzed in a linear mixed effects model.

RESULTS

The mean trustworthiness ratings of the control excerpts ranged from 32.59 to 62.31 (rating scale 0-100). Compared with the control excerpts, excerpts containing only misspellings were rated as being 8.86 points less trustworthy, those containing inappropriate capitalization were rated as 6.41 points less trustworthy, and those containing the combination of misspelling and capitalization were rated as 14.33 points less trustworthy (P<.001 for all). Misspelling and inappropriate capitalization show an additive effect.

CONCLUSIONS

Distinct indicators of incivility independently and additively penalize the perceived trustworthiness of online text independently of lay insight, eliciting a medium effect size.

Effects of Positive Language and Profession on Trustworthiness and Credibility in Online Health Advice: Experimental Study

Background

When searching for health information, many people use the internet as their first source of information. In online health forums, for example, users post their questions and exchange health advice. In recent years, information givers from various professions have begun to use positive language (indicated by the frequent use of positively valenced adjectives) to communicate their information and persuade their audiences.

Objective

The goal of the current study was to answer the following research questions: (1) How does positive language, in comparison to neutral language, influence the trustworthiness of a person arguing in an online health forum and the credibility of their health claims; (2) How does working for a university, compared to working for a lobbying organization, influence the trustworthiness of a person arguing in an online health forum and the credibility of their health claims; and (3) Do the two factors of language style and professional affiliation interact with each other to influence trustworthiness and credibility judgments?

Methods

In a 2 × 2 between-subject experiment, 242 participants read a post from an online health forum and subsequently rated the trustworthiness of the forum post author and the credibility of their information. Within the post, the professional affiliation (scientist vs lobbyist) and language style (neutral vs positive) of the forum post author was varied.

Results

When the forum post author used a positive language style, they were perceived as less trustworthy (high Machiavellianism [P<.001; η²_p=.076], low Integrity [P=.001; η²_p=.045], and low Benevolence [P=.02; η²_p=.025]) and their information was perceived as less credible (low Message Credibility [P=.001; η²_p=.045]). The professional affiliation of the forum post author did not influence their trustworthiness or the credibility of their information.

Conclusions

When searching for health information, information seekers evaluate the language style of forum posts to decide whether forum post authors are trustworthy and their information is credible.

Undergraduate Medical Students' Search for Health Information Online: Explanatory Cross-Sectional Study

Background

Previous research shows that being a “digital native” or growing up in a digital environment does not necessarily lead to increased digital competencies, such as digital health literacy or evaluation of webpage quality.

Objective

This study showed how medical students searched for health information online, specifically the recommended testing for histamine intolerance, by comparing the use of various search engines (Google, Medisuch, and a website of the student’s choice) to find out more about search strategies in future health professionals. As Medisuch presents a qualitatively better search engine, we assumed that medical students using this search engine might find valid information faster on more reliable webpages, and might recommend the correct diagnostic steps for histamine intolerance to their patients more often than students using a generic search engine like Google.

Methods

Medical students in their third year of study were asked to find the relevant diagnostic steps of histamine intolerance online. They were randomly assigned to use one search engine: Google, their personal choice, or Medisuch. Their process of seeking information online was video recorded.

Results

In total, 140 medical students participated in this study. The total number of webpages found did not differ among the groups (P=.52). Students using Medisuch (P=.02) correctly identified the elimination diet as a relevant diagnostic step more frequently. The provocation test was reported by almost half of the students independent of the search engine used. In general, medical students commonly identified trustworthy webpages in all three groups (Google: 36/44, 82%; free choice: 31/36; 86%; and Medisuch: 35/45, 78%).

Conclusions

The results indicate that medical students were able to find trustworthy health-related information online independent of the search engine used. Medical students that are digital natives seem to have proper internet skills and a knowledge of how to use them. They entered specific medical terms (evidence-based diagnostic steps) or names of reliable webpages (DocCheck) in the search engines to gain correct information. However, it remains to be seen if this behavior can be called true “digital literacy”.

Influence of Enthusiastic Language on the Credibility of Health Information and the Trustworthiness of Science Communicators: Insights From a Between-Subject Web-Based Experiment

Background

To decide whether online health information is reliable, information seekers apply 2 stretegies: first, information seekers can make credibility judgments by using their prior knowledge to evaluate the validity of the encountered health claim. Second, instead of evaluating the health claim itself, information seekers can make trustworthiness judgments by evaluating the character of the information source. In recent years, information givers from various professions have begun to use enthusiastic language to disseminate their information and persuade their audiences.

Objective

To systematically explore this phenomenon, the goal of this study was to answer the following research questions: (1) does an enthusiastic language style, in comparison with a neutral language style, increase the trustworthiness of a person arguing in an online health forum and the credibility of his or her information? (2) does working for a university, in comparison with working for a lobbying organization, increase the trustworthiness of a person arguing in an online health forum and the credibility of his or her information? (3) does working for a university in combination with using an enthusiastic language style result in especially high trustworthiness and credibility ratings?

Methods

In a 2x2 between-subject online experiment, 270 participants read a post from an online health forum and subsequently rated the trustworthiness of the forum post author and the credibility of his information. A total of 2 aspects of the forum post varied, namely the professional affiliation of the forum post author (whether the person introduced himself as a scientist or a lobbyist) and his language style (whether he used a neutral language style or an enthusiastic language style).

Results

When the forum post author used an enthusiastic language style, he was perceived as more manipulative (P<.001), less knowledgeable (P<.001), and his information was perceived as less credible (P<.001). Overall, scientists were perceived as less manipulative (P=.04) than lobbyists. Furthermore, language style and professional affiliation interacted: When the forum post author was a lobbyist, language style did not affect integrity (P=.96) and benevolence (P=.79) ratings. However, when the forum post author was a scientist, enthusiastic language led to lower integrity (P=.002) and benevolence (P<.001) ratings than neutral language.

Conclusions

The current findings illustrate that health information seekers do not just react to online health information itself. In addition, they are also sensitive to the ways in which health information is presented (“Which langue style is used to communicate health information?”) and who presents it (“Who does the health information source work for?”).

When Similarity Beats Expertise-Differential Effects of Patient and Expert Ratings on Physician Choice: Field and Experimental Study

Background

Increasing numbers of patients consult Web-based rating platforms before making health care decisions. These platforms often provide ratings from other patients, reflecting their subjective experience. However, patients often lack the knowledge to be able to judge the objective quality of health services. To account for this potential bias, many rating platforms complement patient ratings with more objective expert ratings, which can lead to conflicting signals as these different types of evaluations are not always aligned.

Objective

This study aimed to fill the gap on how consumers combine information from 2 different sources—patients or experts—to form opinions and make purchase decisions in a health care context. More specifically, we assessed prospective patients’ decision making when considering both types of ratings simultaneously on a Web-based rating platform. In addition, we examined how the influence of patient and expert ratings is conditional upon rating volume (ie, the number of patient opinions).

Methods

In a field study, we analyzed a dataset from a Web-based physician rating platform containing clickstream data for more than 5000 US doctors. We complemented this with an experimental lab study consisting of a sample of 112 students from a Dutch university. The average age was 23.1 years, and 60.7% (68/112) of the respondents were female.

Results

The field data illustrated the moderating effect of rating volume. If the patient advice was based on small numbers, prospective patients tended to base their selection of a physician on expert rather than patient advice (profile clicks beta=.14, P<.001; call clicks beta=.28, P=.03). However, when the group of patients substantially grew in size, prospective patients started to rely on patients rather than the expert (profile clicks beta=.23, SE=0.07, P=.004; call clicks beta=.43, SE=0.32, P=.10). The experimental study replicated and validated these findings for conflicting patient versus expert advice in a controlled setting. When patient ratings were aggregated from a high number of opinions, prospective patients’ evaluations were affected more strongly by patient than expert advice (mean_{patient positive/expert negative}=3.06, SD=0.94; mean_{expert positive/patient negative}=2.55, SD=0.89; F_1,108=4.93, P=.03). Conversely, when patient ratings were aggregated from a low volume, participants were affected more strongly by expert compared with patient advice (mean_{patient positive/expert negative}=2.36, SD=0.76; mean_{expert positive/patient negative}=3.01, SD=0.81; F_1,108=8.42, P=.004). This effect occurred despite the fact that they considered the patients to be less knowledgeable than experts.

Conclusions

When confronted with information from both sources simultaneously, prospective patients are influenced more strongly by other patients. This effect reverses when the patient rating has been aggregated from a (very) small number of individual opinions. This has important implications for how to present health care provider ratings to prospective patients to aid their decision-making process.

The Easier the Better? Comparing the Readability and Engagement of Online Pro- and Anti-Vaccination Articles

Online anti-vaccine articles contribute to the anti-vaccine movement, which leads to recent outbreaks of vaccine-preventable diseases. Previous studies indicate that anti-vaccine articles are easy to read and understand, which may increase their abilities to engage viewers. The present study aims to examine if readability levels are related to engagement. Using combination of terms to search for vaccine articles in Google in May 2017, this study examined 541 pro-vaccine online articles with a total of 508,571 words and 382 anti-vaccine articles with a total of 843,805 words. Almost all vaccine articles exceeded the American average reading comprehension level. No significant difference in readability was found between pro- and anti-vaccine articles. Pro-vaccine articles that could only be understood by college graduates were less engaging than those with lower readability levels. No significant relationship between anti-vaccine articles’ readability and engagement was discovered. Different vaccine topics had different readability and engagement levels, which implied that certain combinations of themes and readability levels could enhance the health messages’ persuasion effect. Recommendations for designing effective health messages are provided.

Hot topics in science communication: Aggressive language decreases trustworthiness and credibility in scientific debates

Current scientific debates, such as on climate change, often involve emotional, hostile, and aggressive rhetorical styles. Those who read or listen to these kinds of scientific arguments have to decide whom they can trust and which information is credible. This study investigates how the language style (neutral vs aggressive) and the professional affiliation (scientist vs lobbyist) of a person arguing in a scientific debate influence his trustworthiness and the credibility of his information. In a 2 X 2 between-subject online experiment, participants watched a scientific debate. The results show that if the person was introduced as a lobbyist, he was perceived as less trustworthy. However, the person's professional affiliation did not affect the credibility of his information. If the person used an aggressive language style, he was perceived as less trustworthy. Furthermore, his information was perceived as less credible, and participants had the impression that they learned less from the scientific debate.

Investigating the Role of Communication for Information Seekers' Trust-Related Evaluations of Health Videos on the Web: Content Analysis, Survey Data, and Experiment

Background

According to the language expectancy theory and the communication accommodation theory, health information seekers’ trust evaluations of Web-based videos are determined by interplays between content and seekers’ expectations on vloggers’ appropriate language use in specific contexts of Web-based communication.

Objectives

Two investigations focused on differences both between vloggers’ language styles and between users’ general trust in specific Web-based platforms to investigate how the context of Web-based communication can be characterized (research question, RQ1). Thereafter, we investigated whether information uncertainty, vloggers’ language style, and context of Web-based communication affect seekers’ trust evaluations of videos (RQ2).

Methods

With a content analysis of 36 health videos from YouTube and Vimeo, we examined the extent of trust-related linguistic characteristics (ie, first-person and second-person pronouns). Additionally, we surveyed participants (n=151) on their trust in YouTube and Moodle (academic Web-based platform; RQ1). In an experiment, further participants (n=124) watched a video about nutrition myths and were asked to evaluate the information credibility, vloggers’ trustworthiness, and accommodation of language by vloggers (RQ2). Following a 3 × 2 × 2 mixed design, vloggers’ explanations contained unambiguous (confirming or disconfirming) or ambiguous (neither confirming nor disconfirming) evidence on the myths (within factor). Furthermore, vloggers used YouTube-typical language (many first-person pronouns) or formal language (no first-person pronouns), and videos were presented on YouTube or Moodle (between factors).

Results

The content analysis revealed that videos on YouTube contained more first-person pronouns than on Vimeo (F_1,35=4.64; P=.04; η_p²=0.12), but no more second-person pronouns (F_1,35=1.23; P=.23). Furthermore, when asked about their trust in YouTube or Moodle, participants trusted YouTube more than Moodle (t₁₅₀≤−9.63; all P ≤.001). In the experiment, participants evaluated information to be more credible when information contained unambiguous rather than ambiguous evidence (F_2,116=9.109; P<.001; η_p²=0.14). Unexpectedly, information credibility did not depend on vloggers’ language style or the video platform (F_1,117≤2.40; P ≥.06). Likewise, video’s platform did not affect participants’ evaluations of vloggers’trustworthiness (F_1,117<0.18; P>.34). However, participants judged vloggers who used a YouTube-typical language as being more benevolent, and their language use as being more appropriate in both video platforms (F_1,117≥3.41; P ≤.03; η_p²≥0.028). Moreover, participants rated the YouTube-typical (vs formal) language as more appropriate for Moodle, but they did not rate one or the other language style as more appropriate for YouTube (F_1,117=5.40; P=.01; η_p²=0.04).

Conclusions

This study shows that among specific Web-based contexts, users’ typical language use can differ, as can their trust-related evaluations. In addition, health information seekers seem to be affected by providers’ language styles in ways that depend on the Web-based communication context. Accordingly, further investigations that would identify concrete interplays between language style and communication context might help providers to understand whether additional information would help or hurt seekers’ ability to accurately evaluate information.

The Human Interface of Biomedical Informatics

Biomedical informatics is the science of information, where information is defined as data with meaning. This definition identifies a fundamental challenge for informaticians: connecting with the healthcare team by enabling the acquisition, retrieval, and processing of information within the cognitive capabilities of the human brain. Informaticians can become aware of the constraints involved with cognitive processing and with workplace factors that impact how information is acquired and used to facilitate an improved user interface providing information to healthcare teams. Constraints affecting persons in the work environment include as follows: (1) cognitive processing of information; (2) cognitive load and memory capacity; (3) stress-affecting cognition; (4) cognitive distraction, attention, and multitasking; (5) cognitive bias and flexibility; (6) communication barriers; and (7) workplace environment. The human brain has a finite cognitive load capacity for processing new information. Short-term memory has limited throughput for processing of new informational items, while long-term memory supplies immediate simultaneous access to multiple informational items. Visual long-term memories can be extensive and detailed. Attention may be task dependent and highly variable among persons and requires maintaining control over distracting information. Multitasking reduces the effectiveness of working memory applied to each task. Transfer of information from person to person, or machine to person, is subject to cognitive bias and environmental stressors. High-stress levels increase emotional arousal to reduce memory formation and retrieval. The workplace environment can impact cognitive processes and stress, so maintaining civility augments cognitive abilities. Examples of human-computer interfaces employing principles of cognitive informatics inform design of systems to enhance the user interface.

Online Decision Support Tool for Personalized Cancer Symptom Checking in the Community (REACT): Acceptability, Feasibility, and Usability Study

Background

Improving cancer survival in the UK, despite recent significant gains, remains a huge challenge. This can be attributed to, at least in part, patient and diagnostic delays, when patients are unaware they are suffering from a cancerous symptom and therefore do not visit a general practitioner promptly and/or when general practitioners fail to investigate the symptom or refer promptly. To raise awareness of symptoms that may potentially be indicative of underlying cancer among members of the public a symptom-based risk assessment model (developed for medical practitioner use and currently only used by some UK general practitioners) was utilized to develop a risk assessment tool to be offered to the public in community settings. Such a tool could help individuals recognize a symptom, which may potentially indicate cancer, faster and reduce the time taken to visit to their general practitioner. In this paper we report results about the design and development of the REACT (Risk Estimation for Additional Cancer Testing) website, a tool to be used in a community setting allowing users to complete an online questionnaire and obtain personalized cancer symptom-based risk estimation.

Objective

The objectives of this study are to evaluate (1) the acceptability of REACT among the public and health care practitioners, (2) the usability of the REACT website, (3) the presentation of personalized cancer risk on the website, and (4) potential approaches to adopt REACT into community health care services in the UK.

Methods

Our research consisted of multiple stages involving members of the public (n=39) and health care practitioners (n=20) in the UK. Data were collected between June 2017 and January 2018. User views were collected by (1) the “think-aloud” approach when participants using the website were asked to talk about their perceptions and feelings in relation to the website, and (2) self-reporting of website experiences through open-ended questionnaires. Data collection and data analysis continued simultaneously, allowing for website iterations between different points of data collection.

Results

The results demonstrate the need for such a tool. Participants suggest the best way to offer REACT is through a guided approach, with a health care practitioner (eg, pharmacist or National Health Service Health Check nurse) present during the process of risk evaluation. User feedback, which was generally consistent across members of public and health care practitioners, has been used to inform the development of the website. The most important aspects were: simplicity, ability to evaluate multiple cancers, content emphasizing an inviting community “feel,” use (when possible) of layperson language in the symptom screening questionnaire, and a robust and positive approach to cancer communication relying on visual risk representation both with affected individuals and the entire population at risk.

Conclusions

This study illustrates the benefits of involving public and stakeholders in developing and implementing a simple cancer symptom check tool within community. It also offers insights and design suggestions for user-friendly interfaces of similar health care Web-based services, especially those involving personalized risk estimation.

Social Media and Obesity in Adults: a Review of Recent Research and Future Directions

PURPOSE OF REVIEW

Social media is widely used and has potential to connect adults with obesity with information and social support for weight loss and to deliver lifestyle interventions. The purpose of this review is to summarize recent observational and intervention research on social media and obesity.

RECENT FINDINGS

Online patient communities for weight loss abound but may include misinformation. Systematic reviews and meta-analyses suggest that social media-delivered lifestyle interventions modestly impact weight, yet how social media was used and participant engagement varies widely. The rapidly changing social media landscape poses challenges for patients, clinicians, and researchers. Research is needed on how patients can establish supportive communities for weight loss and the role of clinicians in these communities. Emerging research on meaningful engagement in, and the efficacy and cost-effectiveness of, social media-delivered lifestyle interventions should provide insights into how to leverage social media to address the obesity epidemic.