Relationship Between Internet Health Information and Patient Compliance Based on Trust: Empirical Study

Analysis of prescription compliance and influencing factors in cardiac rehabilitation after surgery in children with congenital heart disease based on generalized trust theory

AIMS

To understand the compliance, influencing factors, and action path of family cardiac rehabilitation exercise prescriptions for children after congenital heart disease surgery.

METHODS AND RESULTS

A random sampling method was used to select 200 paediatric patients and their parents from a paediatric hospital in Shanghai. Among them, 57 cases (28.5%) of children's families followed the cardiac rehabilitation exercise prescription. Path analysis showed that peak oxygen uptake exerted a negative impact on the compliance of family cardiac-rehabilitation prescriptions for patients after congenital heart disease surgery through doctor-patient trust, with a standardized path coefficient of -0.246 (P = 0.001). Disease-related knowledge exerted a positive effect on the compliance of family cardiac-rehabilitation prescriptions for children after congenital heart surgery through doctor-patient trust, with a standardized path coefficient of 0.353 (P < 0.001). The dimension of friend support in social support had a direct positive effect on the compliance of family cardiac-rehabilitation prescriptions for children after cardiac surgery, with a standardized path coefficient of 0.641 (P = 0.006).

CONCLUSION

The compliance of cardiac rehabilitation exercise prescription in children with congenital heart disease is not good and is affected by many factors, and there is a complex path relationship between various factors; the kilogram oxygen consumption of the child, the disease-related knowledge of the caregiver, and social support all play important roles in the compliance of the child's family's health prescription.

REGISTRATION

ChiCTR2200062022.

The impact of digital literacy on personal health: Evidence from the China family panel study

BACKGROUND

In the digital era, digital literacy is a fundamental indicator of a nation's quality and plays a crucial role in public health. Exploring the theoretical mechanisms and effects of digital literacy on individuals' health is of great practical importance, advancing the initiatives of 'Digital China' and 'Healthy China'.

METHODS

The study utilised three-period survey panel data from the China Family Panel Study spanning 2016, 2018, and 2020 to measure and evaluate levels of digital literacy, physical health, mental health, healthy lifestyle, and integrated health among the participants. Subsequently, a series of empirical analyses were conducted to examine the general impact, heterogeneous effects and transmission pathways of digital literacy on various types of health levels.

RESULTS

Digital literacy significantly enhances all aspects of respondents' health, and this conclusion remains valid even after conducting robustness tests and addressing endogeneity through variable substitution and selecting instrumental variables using the 2SLS method. Furthermore, examining heterogeneity by considering individual traits and the makeup of digital literacy reveals that the impact of digital literacy on individuals' health varies according to age, cultural background, personal income, and the components of digital literacy. Pathway analyses also demonstrate that medical accessibility, information access, social network, and planned behaviour are key routes through which digital literacy enhances the health of the population.

CONCLUSIONS

It is imperative for the government to actively promote the advancement of the digital healthcare industry, while individuals should strive to enhance their digital literacy. By collectively focussing on these efforts, national health can be significantly improved.

Influence of believed AI involvement on the perception of digital medical advice

Large language models offer novel opportunities to seek digital medical advice. While previous research primarily addressed the performance of such artificial intelligence (AI)-based tools, public perception of these advancements received little attention. In two preregistered studies (n = 2,280), we presented participants with scenarios of patients obtaining medical advice. All participants received identical information, but we manipulated the putative source of this advice ('AI', 'human physician', 'human + AI'). 'AI'- and 'human + AI'-labeled advice was evaluated as significantly less reliable and less empathetic compared with 'human'-labeled advice. Moreover, participants indicated lower willingness to follow the advice when AI was believed to be involved in advice generation. Our findings point toward an anti-AI bias when receiving digital medical advice, even when AI is supposedly supervised by physicians. Given the tremendous potential of AI for medicine, elucidating ways to counteract this bias should be an important objective of future research.

What Encourages Patients to Recommend Their Doctor After an Online Medical Consultation? The Influence of Patient-Centered Communication, Trust, and Negative Health Information Seeking Experiences

The doctor-patient relationship in China has become increasingly tense, with patients lacking trust in doctors. Meanwhile, online healthcare flourished, accelerated by the COVID-19 pandemic. This study utilized the direct and indirect pathway model of clinician-patient communication to health outcomes and online trust theory to examine the associations between online patient-centered communication (OPCC), benevolence and ability trust in doctors, negative online health information seeking experiences, and willingness to recommend doctors. The findings revealed that benevolence and ability trust mediated the relationship between OPCC and willingness to recommend doctors. Additionally, when participants had a high level of negative online health information seeking experiences, OPCC had a stronger effect on ability trust; meanwhile, the mediation effect of ability trust between the relationship of OPCC and willingness to recommend was stronger. This study also discussed theoretical and practical implications.

Examination of the reliability and readability of Chatbot Generative Pretrained Transformer's (ChatGPT) responses to questions about orthodontics and the evolution of these responses in an updated version

INTRODUCTION

This study aimed to assess the reliability and readability of Chatbot Generative Pretrained Transformer (ChatGPT) responses to questions about orthodontics and the evolution of these responses in an updated version.

METHODS

Frequently asked questions about orthodontics by laypeople on Web sites were determined using the Google Search Tool. These questions were asked to both ChatGPT's March 23 version and May 24 version on April 20, 2023, and July 12, 2023, respectively. Responses were assessed for readability and reliability using the Flesch-Kincaid and DISCERN tests.

RESULTS

The mean DISCERN value for general questions was 2.96 ± 0.05, 3.04 ± 0.06, 2.38 ± 0.27, and 2.82 ± 0.31 for treatment-related questions; the mean Flesch-Kincaid Reading Ease score for general questions was 29.28 ± 8.22, 25.12 ± 7.39, 47.67 ± 10.77, and 41.60 ± 9.54 for treatment-related questions; mean Flesch-Kincaid Grade Level for general questions was 14.52 ± 1.48 and 14.04 ± 1.25 and 11.90 ± 2.08 and 11.41 ± 1.88 for treatment-related questions; in first and second evaluations respectively (P = 0.001).

CONCLUSIONS

In the second evaluation, the reliability of the answers given to general questions and treatment-related questions increased. However, in both evaluations, the reliability of the answers was found to be moderate according to the DISCERN tool. On the second evaluation, Flesch Reading Ease Scores for both general questions and treatment-related questions decreased, meaning that the readability of the new response texts became more difficult. Flesch-Kincaid Grade Level results were found at the college graduate level in the first and second evaluations for general questions and at the high school level in the first and second evaluations for treatment-related questions.

Assessing the Influence of Patient Empowerment Gained Through Mental Health Apps on Patient Trust in the Health Care Provider and Patient Compliance With the Recommended Treatment: Cross-sectional Study

BACKGROUND

In chronic mental illness, noncompliance with treatment significantly worsens the illness course and outcomes for patients. Considering that nearly 1 billion people worldwide experience mental health issues, including 1 of 5 Canadians in any given year, finding tools to lower noncompliance in these populations is critical for health care systems. A promising avenue is apps that make mental health services more accessible to patients. However, little is known regarding the impact of the empowerment gained from mental health apps on patient compliance with recommended treatment.

OBJECTIVE

This study aimed to investigate the impact of patient empowerment gained through mental health apps on patient trust in the health care provider and patient compliance with the recommended treatment.

METHODS

A cross-sectional web-based survey was conducted in Canada. Eligible participants were Canadian adults diagnosed with chronic mental health disorders who were using at least one of the following apps: Dialogue, MindBeacon, Deprexis, Ginger, Talkspace, BetterHelp, MindStrong, Mindshift, Bloom, Headspace, and Calm. A total of 347 valid questionnaires were collected and analyzed using partial least-squares structural equation modeling. Trust in the health care provider and patient compliance were measured with multiple-item scales adapted from existing scales. Patient empowerment was conceived and measured as a higher-order construct encompassing the following 2 dimensions: patient process and patient outcome. All the items contributing to the constructs in the model were measured with 7-point Likert scales. The reliability and validity of the measurement model were assessed, and the path coefficients of the structural model were estimated.

RESULTS

The results clearly show that patient empowerment gained through mental health apps positively influenced patient trust in the health care provider (β=.306; P<.001). Patient trust in the health care provider had a positive effect on patient compliance (β=.725; P<.001). The direct relationship between patient empowerment and patient compliance was not significant (β=.061, P=.23). Interestingly, the data highlight that the effect of patient empowerment on patient compliance was fully mediated by trust in the health care provider (β=.222; P<.001). The results show that patient empowerment gained through the mental health app involves 2 dimensions: a process and an outcome.

CONCLUSIONS

This study shows that for individuals living with mental health disorders, empowerment gained through mental health apps enhances trust in the health care provider. It reveals that patient empowerment impacts patient compliance but only through the full mediating effect of patient trust in the health care provider, indicating that patient trust is a critical variable to enhance patient compliance. Hence, our results confirm that health care systems could encourage the use of mental health apps to favor a climate that facilitates patients' trust in health care provider recommendations, possibly leading to better compliance with the recommended treatment.

From Waterloo to the Great Wall: A retrospective, multicenter study on the clinical practice and cultural attitudes in the management of premature ejaculation, in China

Premature ejaculation (PE), despite its wide prevalence, is largely underdiagnosed and undertreated. Being a multifactorial dysfunction with strong cultural characteristics, PE requires skillful attitudes in the psychosexological support, necessary to manage the patient's and the couple's expectations, as well as in the medical treatment. Dapoxetine is a short-acting selective serotonin reuptake inhibitor approved for use in lifelong and acquired PE in a number of countries. Opinions, not always generated by the evidence-based medicine, impacted the attitudes of Western andrologists, as a nocebo effect which produced a drug's Waterloo, characterized by low prescription rates much more built on the patients' and doctors' expectations than on costs, side effects, and efficacy. In the present study, we retrospectively reviewed real-life data from eight Andrology and Sexual Medicine Public Centers in China to assess the prevalence of PE among attending patients, its association with erectile dysfunction, its subtype, and the proposed treatments. In 2019, among 156,486 patients coming to the centers, 32,667 visits having PE as the chief complaint were performed (20.9%). Almost all patients received treatment prescriptions (32,641 patients, 99.92%); 23,273 patients came back for a follow-up visit in the subsequent 12 months (71.2% of those who initially received treatment). Dapoxetine, either alone or in combination with another therapy, was the most prevalent treatment, prescribed to 22,767 patients (69.7% of treated patients), followed by traditional Chinese medicine (TCM) (39.4%). At follow-up, 8174 patients were unsatisfied with treatment, and a new treatment was proposed (35.12%). Dapoxetine was the best treatment, with an overall 27.1% switching rate when used either alone or in combination: Although the switching rate for Dapoxetine alone was 44.2%, the association of the same drug with psychotherapy resulted in much lower rates (19.5%) and reached a minimum of 12% when also combined with TCM demonstrating how cultural aspects and medical attitudes may dramatically impact on the therapy of a multifaceted, complex, and culture-grounded sexual symptom such as PE. In conclusion, taking switching rates as surrogate markers of treatment failure, this real-life study-the largest in the field-shows that in a more patient-oriented (as in Chinese medical culture), and less symptom-oriented (as in Western medical attitudes), Dapoxetine is a successful treatment for PE patients, with higher reliability when used alone or as part of combined and integrated therapies.

Patient compliance: A concept analysis

Background

Patient compliance with regimens is one of the most researched and least-understood behavioral concerns in the healthcare profession due to the many meanings employed in multidiscipline over time. Thus, a thorough examination of the idea of patient compliance is necessary.

Objective

This paper aims to explore and identify the essence of the term patient compliance to achieve an operational definition of the concept.

Method

Walker and Avant's eight-step approach was used. A literature search was conducted using keywords of patient compliance AND healthcare profession from five databases: PubMed, Medline, CINAHL, ProQuest, ScienceDirect, and Cochrane database, published from 1995 to 2022.

Results

The attributes of patient compliance include 1) self-care behavior, 2) following health recommendations, and 3) willing collaboration with health professionals. Antecedents of patient compliance were characteristics of therapeutic regimens, communication of health advice, and patients' attitudes toward professional recommendations. Consequences include improved clinical outcomes, quality of life, and lifestyle or behavior modification.

Conclusion

This concept analysis offers a valuable perspective on patient compliance that guides the nursing practice in providing better interventions to promote compliance among patients.

Media exposure, trustworthiness of sources and the health information literacy knowledge gap: a study in China

Health information literacy (HIL), as an essential part of the wellbeing of citizens, is a crucial indicator used to measure a country's primary public health level. The present study collected 1051 samples in southern China to examine the factors predicting HIL. The results showed that males, those less educated, and older adults had lower HIL. Television exposure, unofficial Internet exposure, trust in government and trust in doctors and medical institutions were positively associated with HIL. In contrast, newspapers, radio exposure and trust in web celebrities were negatively associated with HIL. Official Internet media exposure helps to bridge the HIL knowledge gap generated by differences in education level, while trust in celebrities-especially web celebrities-could widen the HIL knowledge gap. This study extends the knowledge gap theory in health communication in the Chinese context and provides pathways for future health interventions.

Repetitions in online doctor-patient communication: Frequency, functions, and reasons

OBJECTIVES

To attain insights into language repetition during online doctor-patient communication (DPC), understand why doctors and patients use repetition, and improve the current deficiencies in online medical platforms.

METHODS

The study performed a content analysis of 72 sets of textual doctor-patient conversations on the Chinese online medical consultation platform Chunyu Doctor.

RESULTS

Repetitions occurred 1412 times in the 72 sets of online DPC. Patient self-repetitions were the most prevalent (30.7 %), while patient repetitions of doctors were the least common (17.1 %). Doctors used repetitions for explanations and affirmations. Patients used repetition for emphasis, verification, and turn-taking. The repetition frequencies of doctors and patients were primarily influenced by personal factors. However, doctor-dimension factors exerted a greater impact on the frequency of patient repetitions.

CONCLUSIONS

The reasons for repetitions in online DPC differ from those offline. Online DPC increases patient initiative and reduces doctor authority. Nevertheless, it could be affected by gender stereotypes generated during offline consultations. Doctors still dominated the conversations but attended sufficiently to the patient discourse. Online DPC is gradually attempting to fulfill the expectations of a new patient-centered healthcare pattern.

PRACTICAL IMPLICATIONS

The findings yield suggestions for healthcare providers and the designers of online healthcare platforms.

'You have to have a level of trust': Consumer-described health literacy barriers and enablers to engaging with health care professionals

ISSUE ADDRESSED

Health literacy - the degree to which people can access, understand and use health information - is essential for shared decision-making and improved health outcomes. Health consumers' ability to engage with health care professionals (HCPs) is influenced by their health literacy capabilities. This research sought to understand health literacy-related barriers and enablers to engage with non-physician HCPs as experienced by consumers.

METHODS

A qualitative descriptive approach was undertaken. A semi-structured interview guide was used, incorporating five health literacy domains described in the Health Literacy Questionnaire that related to consumers' engagement with health professionals. Audio- or digitally-recorded interviews were conducted with Australian health consumers, and transcribed and themed using the Patient-centred Access to Care framework as a template.

RESULTS

Interviewing 30 consumers revealed that HCPs' clinical skills often enabled consumers to seek engagement; however, during active engagement their interpersonal skills became a key enabler. Conversely, a lack of developed interpersonal skills in HCPs was frequently seen as a barrier to consumer engagement. Barriers to engagement were also created when HCPs' information did not match what consumers discovered from other sources. However, consumers self-reported that they were unable to appraise health information at least some of the time.

CONCLUSION

Barriers and enablers to consumers' engagement with HCPs were identified across each of the five relevant health literacy domains. SO WHAT?: HCPs should be aware of the importance of interpersonal skills and clear health information suitable for consumers with lower health literacy. Additionally, time dedicated to educating consumers on information appraisal could act as a further enabler to effective engagement.

The Effects of Patient Health Information Seeking in Online Health Communities on Patient Compliance in China: Social Perspective

BACKGROUND

Online health communities (OHCs) can alleviate the uneven distribution and use of medical resources and severe hospital congestion. Patients may seek health information through OHCs before or after visiting physicians, which may affect their cognition, health literacy, decision-making preferences, and health-related behaviors such as compliance. Social factors (social support, social presence, and responsiveness) are closely related to patients' health information-seeking behavior and are significantly considered in OHCs.

OBJECTIVE

This study aimed to explore the effects of patients' health information-seeking behavior (way and effectiveness) on compliance with physicians from the perspectives of patients' perceived social support, social presence, and responsiveness.

METHODS

This study established a research model from the perspective of social information processing by using the social exchange theory. An anonymous questionnaire survey was conducted with several Chinese OHCs to collect data. Partial least squares and structural equation modeling were adopted to test the hypotheses and develop the model.

RESULTS

This study received 403 responses, of which 332 were valid, giving a validity rate of 82.4% (332/403). Among the sample, 78.6% (261/332) of the individuals were aged between 20 and 40 years, 59.3% (197/332) were woman, 69.9% (232/332) lived in urban areas, and 50% (166/332) had at least a bachelor's degree. The reliability, convergent validity, and discriminant validity were acceptable. Both the way and effectiveness of patients seeking health information through OHCs have a positive impact on their compliance through the mediation of their perceived social support, social presence, and responsiveness from OHCs and other users, and patient compliance can be improved by guiding patient health information-seeking behavior in OHCs from a social perspective.

CONCLUSIONS

This study proposes a research model to corroborate that patient health information-seeking behavior (way and effectiveness) in OHCs exerts positive effects on patient compliance with the treatment and physician's advice and provides suggestions for patients, physicians, and OHC service providers in China to help guide patients' health-related behaviors through OHCs to improve patient compliance, patient satisfaction, treatment efficiency, and health outcomes.

Predicting Fact-Checking Health Information Before Sharing Among People with Different Levels of Altruism: Based on the Influence of Presumed Media Influence

Background

Pervasive health misinformation on social media affects people's health. Fact-checking health information before it is shared is an altruistic behavior that effectively addresses health misinformation on social media.

Purpose

Based on the influence of presumed media influence (IPMI), this study serves two purposes: The first is to investigate factors that influence social media users' decisions to fact-check health information before sharing it in accordance with the IPMI model. The second is to explore different predictive powers of the IPMI model for individuals with different levels of altruism.

Methods

This study conducted a questionnaire survey of 1045 Chinese adults. Participants were divided into either a low-altruism group (n = 545) or a high-altruism group (n = 500) at the median value of altruism. A multigroup analysis was conducted with R Lavaan package (Version 0.6-15).

Results

All of the hypotheses were supported, which confirms the applicability of the IPMI model in the context of fact-checking health information on social media before sharing. Notably, the IPMI model yielded different results for the low- and high-altruism groups.

Conclusion

This study confirmed the IPMI model can be employed in the context of fact-checking health information. Paying attention to health misinformation can indirectly affect an individual's intention to fact-check health information before they share it on social media. Furthermore, this study demonstrated the IPMI model's varying predictive powers for individuals with different altruism levels and recommended specific strategies health-promotion officials can take to encourage others to fact-check health information.

Patient Trust in Physicians Matters-Understanding the Role of a Mobile Patient Education System and Patient-Physician Communication in Improving Patient Adherence Behavior: Field Study

BACKGROUND

The ultimate goal of any prescribed medical therapy is to achieve desired outcomes of patient care. However, patient nonadherence has long been a major problem detrimental to patient health and, thus, is a concern for all health care providers. Moreover, nonadherence is extremely costly for global medical systems because of unnecessary complications and expenses. Traditional patient education programs often serve as an intervention tool to increase patients' self-care awareness, disease knowledge, and motivation to change patient behaviors for better adherence. Patient trust in physicians, patient-physician relationships, and quality of communication have also been identified as critical factors influencing patient adherence. However, little is known about how mobile patient education technologies help foster patient adherence.

OBJECTIVE

This study aimed to empirically investigate whether and how a mobile patient education system (MPES) juxtaposed with patient trust can increase patient adherence to prescribed medical therapies.

METHODS

This study was conducted based on a field survey of 125 patients in multiple states in the United States who have used an innovative mobile health care system for their health care education and information seeking. Partial least squares techniques were used to analyze the collected data.

RESULTS

The results revealed that patient-physician communication and the use of an MPES significantly increase patients' trust in their physicians. Furthermore, patient trust has a prominent effect on patient attitude toward treatment adherence, which in turn influences patients' behavioral intention and actual adherence behavior. Based on the theory of planned behavior, the results also indicated that behavioral intention, response efficacy, and self-efficacy positively influenced patients' actual treatment adherence behavior, whereas descriptive norms and subjective norms do not play a role in this process.

CONCLUSIONS

Our study is one of the first that examines the relationship between patients who actively use an MPES and their trust in their physicians. This study contributes to this context by enriching the trust literature, addressing the call to identify key patient-centered technology determinants of trust, advancing the understanding of patient adherence mechanisms, adding a new explanation of the influence of education mechanisms delivered via mobile devices on patient adherence, and confirming that the theory of planned behavior holds in this patient adherence context.

"Digital Dividend" or "Digital Divide": What Role Does the Internet Play in the Health Inequalities among Chinese Residents?

With the vigorous development of the medical industry in China, residents' health has been significantly improved. However, along with the income gap, urban-rural gap, and healthcare resource gap caused by economic development, health inequality has become a fundamental barrier to the promotion of residents' health. The popularity of the Internet has helped close the gap to some extent, but it also has drawbacks. Using data from the China Family Panel Studies (CFPS) from 2014 to 2018, we evaluated the effects of Internet usage on health disparities among residents using fixed effect models, mediation effect models, and other methodologies. The findings indicate that Internet usage can help to minimize health inequality since it lowers income inequality, promotes health consciousness, and reduces depression. Furthermore, Internet usage plays a greater role on the health improvement of the middle-aged, the elderly, urban residents, and females. Although the Internet has brought "digital dividends" in general, the Internet usage rates among different groups also reveal that there is a clear "digital gap" among rural residents, elderly groups, and low-income groups. These results have significant implications for promoting healthcare equality.

Impacts of Internet Use on Chinese Patients' Trust-Related Primary Healthcare Utilization

Background: The internet has greatly improved the availability of medical knowledge and may be an important avenue to improve patients’ trust in physicians and promote primary healthcare seeking by reducing information asymmetry. However, very few studies have addressed the interactive impacts of both patients’ internet use and trust on primary healthcare-seeking decisions. Objective: To explore the impact of internet use on the relationship between patients’ trust in physicians and primary healthcare seeking among Chinese adults 18 years of age and older to understand the varieties of effects in different cities. Methods: Generalized linear mixed models were applied to investigate the interactive impacts of internet use and patients’ trust in physicians on primary healthcare seeking using pooled data from the China Family Panel Study of 2014 to 2018. We also compared these effects based on different levels of urbanization, ages, and PHC services. Results: Overall, a higher degree of patients’ trust (p < 0.001) was able to directly predict better primary healthcare seeking, and internet use significantly increased the positive effect of patients’ trust on primary healthcare seeking (p < 0.001). However, the marginal effect analysis showed that this effect was related to the level of patients’ trust and that internet use could reduce the positive effect of patients’ trust on primary healthcare seeking when the individual had a low level of trust (≤ 3 units). Further, the heterogeneity analysis indicated that the benefits from internet use were higher in cities with high urbanization, high aging, and high PHC service levels compared to cities with low levels of these factors. Conclusions: The internet use may enhance patients’ trust-related PHC utilization. However, this impact is effective only if patients’ benchmark trust remains at a relatively high level. Comparatively, the role of internet use is more effective in areas with high urbanization, high aging and high PHC level. Thus, with increasing accessibility to the internet, the internet should be regulated to disseminate correct healthcare information. Moreover, in-depth integration of the internet and PHC should be promoted to provide excellent opportunities for patient participation, and different strategies should be set according to each city’s characteristics.

Research on the influencing factors of users’ information processing in online health communities based on heuristic-systematic model

With the rapid development of the Internet and the normalization of COVID-19 epidemic prevention and control, Online health communities (OHCs) have gradually become one of the important ways for people to obtain health information, and users have to go through a series of information processing when facing the massive amount of data. Understanding the factors influencing user information processing is necessary to promote users’ health literacy, health knowledge popularization and health behavior shaping. Based on the Heuristic-Systematic Model (HSM), Information Ecology Theory, Privacy Trade-Off and Self-Efficacy Theory, we constructed a model of factors influencing user information processing in online health communities. We found that information quality and emotional support had indirect effects on heuristic and systematic information processing, and these effects were mediated by privacy concerns and self-efficacy. In our research model, systematic information processing was most positively influenced directly by self-efficacy. Privacy concerns had a direct negative correlation with both dual information processing pathways. Therefore, OHCs managers should develop relevant regulations to ensure the information quality in OHCs and improve privacy protection services to promote user information processing by improving users’ self-efficacy and reducing their privacy concerns. Providing a user-friendly and interactive environment for users is also recommended to create more emotional support, thus facilitating more systematic information processing.

Factors influencing patients' opt-in intention of exchanging health information

Introduction

Health information exchange (HIE) exhibits tremendous benefits in improving the quality of healthcare and reducing healthcare costs. However, it also poses challenges related to data security, data privacy, patient engagement, etc.

Objective

This study aimed to explore the factors affecting patients' opt-in intention to HIE by using an empirical study based on the theory of planned behavior.

Methods

A Web-based survey was conducted involving 501 valid participants in China (69% validity rate).

Results

Information sensitivity and perceived HIE transparency affected the patients' opt-in intention to HIE through the mediation of perceived behavior control and trust in HIE. Information sensitivity negatively influenced perceived behavior control (-0.551, P < 0.001) and trust in HIE (-0.489, P < 0.001). Perceived transparency of HIE positively influenced perceived behavior control (0.396, P < 0.001) and trust in HIE (0.471, P < 0.001). Moreover, patients' opt-in intention to HIE can be positively affected by perceived HIE transparency (0.195, P < 0.001) and trust in HIE (0.294, P < 0.001). In addition, the moderating effect of health status was positive and significant between trust in HIE and opt-in intention to HIE but not between the perceived behavior control and opt-in intention to HIE.

Conclusion

This study contributes to the theory of planned behavior and enriches the literature on HIE efforts. HIE administrators should design personalized health services on the basis of these different health statuses to successfully achieve patients' opt-in intention to HIE.

Empowerment for behaviour change through social connections: a qualitative exploration of women's preferences in preconception health promotion in the state of Victoria, Australia

BACKGROUND

Health behaviours in the preconception period have the potential to impact on fertility and pregnancy outcomes, and the health of all women regardless of pregnancy intention. Public awareness of this is low and interventions that promote behaviour change have not been integrated into real-world settings. Aims were to explore women's understandings of health and health behaviours and what supports are important to promote behaviour change in the preconception period.

METHODS

This qualitative study is the first phase of a broader co-design project set in the state of Victoria, Australia. Over 3 months, a series of in-depth interviews were conducted with female participants who were intending to become pregnant in the next 2 years (n = 6) and participants who were not intending to become pregnant in the next 2 years (n = 6). Community advisors (n = 8) aged 18-45 years provided feedback throughout the process. Coding of transcripts from interviews and meetings was undertaken by two researchers before a deductive process identified themes mapped to the COM-B framework.

RESULTS

Nine themes and eight sub-themes were identified. Participants had a holistic view of health with nutrition, physical activity and sleep being most valued. Social connections were considered as being important for overall health and wellbeing and for promoting health behaviours. The only difference between groups was that pregnancy was an additional motivator for women who were planning to become pregnant in the next 2 years. A range of health information is available from health professionals and other sources. Unlimited access to information was empowering but sometimes overwhelming. Being listened to and shared experiences were aspects of social connections that validated participants and guided them in their decision-making.

CONCLUSIONS

Women valued their health and had a holistic view that includes physical, mental and social dimensions. Women viewed social connections with others as an opportunity to be listened to and to gain support that empowers behaviour change. Future interventions to promote behaviour change in preconception women should consider the importance all women placed on social connections and leverage off existing resources to connect women.

An evaluation index system for regional mobile SARS-CoV-2 virus nucleic acid testing capacity in China: a modified Delphi consensus study

Background

Large-scale detection has great potential to bring benefits for containing the COVID-19 epidemic and supporting the government in reopening economic activities. Evaluating the true regional mobile severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus nucleic acid testing capacity is essential to improve the overall fighting performance against this epidemic and maintain economic development. However, such a tool is not available in this issue. We aimed to establish an evaluation index system for assessing the regional mobile SARS-CoV-2 virus nucleic acid testing capacity and provide suggestions for improving the capacity level.

Methods

The initial version of the evaluation index system was identified based on massive literature and expert interviews. The Delphi method questionnaire was designed and 30 experts were consulted in two rounds of questionnaire to select and revise indexes at all three levels. The Analytic Hierarchy Process method was used to calculate the weight of indexes at all three levels.

Results

The evaluation index system for assessing the regional mobile SARS-CoV-2 virus nucleic acid testing capacity, including 5 first-level indexes, 17 second-level indexes, and 90 third-level indexes. The response rates of questionnaires delivered in the two rounds of consultation were 100 and 96.7%. Furthermore, the authority coefficient of 30 experts was 0.71. Kendall’s coordination coefficient differences were statistically significant (P < 0.001). The weighted values of capacity indexes were established at all levels according to the consistency test, demonstrating that ‘Personnel team construction’ (0.2046) came first amongst the five first-level indexes, followed by ‘Laboratory performance building and maintenance’ (0.2023), ‘Emergency response guarantee’ (0.1989), ‘Information management system for nucleic acid testing resources’ (0.1982) and ‘Regional mobile nucleic acid testing emergency response system construction’ (0.1959).

Conclusion

The evaluation system for assessing the regional mobile SARS-CoV-2 virus nucleic acid testing capacity puts forward a specific, objective, and quantifiable evaluation criterion. The evaluation system can act as a tool for diversified subjects to find the weak links and loopholes. It also provides a measurable basis for authorities to improve nucleic acid testing capabilities.

Shining the Light on Altruism and Its Potential Impact for Behavior Change Strategies Related to the COVID-19 Pandemic and Beyond

The COVID-19 pandemic is shining a light on altruistic behaviors needed to prevent the spread of the virus. This short essay presents a personal experience of altruism during the COVID-19 pandemic and its resulting motivation to leverage it in health behavior change strategies for vaccination and other pandemic protective behaviors.

The psychological mechanism of internet information processing for post-treatment evaluation

Digital healthcare has been greatly benefiting the public health system, especially during the COVID-19 pandemic. In digital healthcare, information communication through the Internet is crucial. The current study explores how patients' accessibility and trust in Internet information influence their decisions and ex-post assessment of healthcare providers by employing the Bayesian Mindsponge Framework (BMF) on a dataset of 1,459 Vietnamese patients. We find that patients' accessibility to Internet information positively affects the perceived sufficiency of information for choosing a healthcare provider, and their trust in the information intensifies this effect. Internet information accessibility is negatively associated with post-treatment assessment of healthcare providers, and trust also moderates this effect. Moreover, patients considering professional reputation important while making a decision are more likely to regard their choices as optimal, whereas patients considering services important have contradicting tendencies. Based on these findings, a concern about the risk of eroding trust toward Internet sources about healthcare information is raised. Thus, quality control and public trust-building measures need to be taken to improve the effectiveness of healthcare-related communication through the Internet and facilitate the implementation of digital healthcare.

eHealth Literacy of Chinese Residents During the Coronavirus Disease 2019 Pandemic: A Cross-sectional Survey

The Coronavirus Disease 2019 (COVID-19) pandemic has become a leading societal concern. eHealth literacy is important in the prevention and control of this pandemic. The purpose of this study is to identify eHealth literacy of Chinese residents about the COVID-19 pandemic and factors influencing eHealth literacy. A total of 15 694 individuals clicked on the link to the questionnaire, and 15 000 agreed to participate and completed the questionnaire for a response rate of 95.58%. Descriptive statistics, χ2 test, and logistic regression analysis were conducted to analyze participants' level of eHealth literacy about COVID-19 and its influencing factors. The results showed 52.2% of participants had relatively lower eHealth literacy regarding COVID-19 (eHealth literacy score ≤ 48). The scores of the information judgment dimension (3.09 ± 0.71) and information utilization dimension (3.18 ± 0.67) of the eHealth literacy scale were relatively lower. The logistics regression showed that sex, age, education level, level of uncertainty, having people around the respondent diagnosed with COVID-19, relationship with family, and relationship with others were associated to eHealth literacy (χ2 = 969.135, P < .001). The public's eHealth literacy about COVID-19 needs to be improved, especially the ability to judge and utilize online information. Close collaboration among global health agencies, governments, healthcare institutions, and media is needed to provide reliable online information to the public. Interventions to improve eHealth literacy should take into account and accentuate the importance of sex, age, educational background, level of uncertainty, exposure to disease, and social support.

Exploring the Online Health Information-Seeking Behavior in a Sample of Italian Women: The "SEI Donna" Study

There is much discussion about the skills of people in understanding and managing online health information. The Italian survey “SEI Donna” aimed to investigate perceptions and use of the web in women regarding health issues considering their health literacy (HL) and healthcare skills. We used an online questionnaire to explore different aspects of online health-related information-seeking behavior. The study participants (n = 7027) were categorized into healthcare workers (HW), healthcare students (HS), and non-healthcare women (non-HW). Half the sample (52%) searched online for a second opinion after the medical examination without statistical difference among HW, HS, and non-HW. Women in the age range of 26−40 years (OR = 1.28, p < 0.001), having chronic illness (OR = 1.48; p < 0.001), and being moderately (OR = 1.58; p < 0.001) or not satisfied (OR = 2.04; p < 0.001) with healthcare professionals were more likely to use the Internet to seek medical insight. Overall, 34% of women had a functional HL, the same being higher in HW (64%) and in HS (43%) than the rest of the women (18%) (p < 0.0001). The suboptimal HL suggests the need to improve HL in the general population to be skilled in surfing the web and, at the same time, to reorganize health training to improve the HL of healthcare professionals, also enriching their communication skills.

Does Internet Use Aggravate Public Distrust of Doctors? Evidence from China

The internet has exacerbated the spillover of medical information, and changes in the quantity, quality, and scope of information supply also affect public trust in doctors, which is of great significance to the construction of a harmonious physician–patient relationship. The objective of this study is to explore the relationship between internet use and residents’ trust in doctors using data from the China Family Panel Studies for 2018. The empirical investigation utilizes an endogenous switching regression model (ESR) to overcome the endogeneity bias. Our results indicate that internet use is negatively associated with residents’ trust in doctors (β = 0.07, p < 0.05). Specifically, the patient trust of internet users is nearly 7 percent less than that of non-internet users. Nevertheless, residents with higher dependence on traditional media such as television, newspapers, magazines and radio as an information channel show stronger patient trust. Finally, the results of the subsample analysis indicate a need to focus on older and less-educated residents, who are more vulnerable and more likely to be affected.

Factors affecting physicians using mobile health applications: an empirical study

Background

Mobile health applications (mHealth apps) have created innovative service channels for patients with chronic diseases. These innovative service channels require physicians to actively use mHealth apps. However, few studies investigate physicians’ participation in mHealth apps.

Objective

This study aims to empirically explore factors affecting physicians’ usage behaviors of mHealth apps. Based on the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) and mHealth apps features, we propose a research model including altruism, cognitive trust, and online ratings.

Methods

We collected data from physicians who have used mHealth apps and conducted a factor analysis to verify the convergence and discriminative effects. We used a hierarchical regression method to test the path coefficients and statistical significance of our research model. In addition, we adopted bootstrapping approach and further analyzed the mediating effects of behavioral intention between all antecedent variables and physicians’ usage behavior. Finally, we conducted three robustness analyses to test the validity of results and tested the constructs to verify the common method bias.

Results

Our results support the effects of performance expectancy, effort expectancy, social influence, and altruism on the behavioral intentions of physicians using mHealth apps. Moreover, facilitating conditions and habits positively affect physicians using mHealth apps through the mediating effort of behavioral intention. Physicians’ cognitive trust and online rating have significant effects on their usage behaviors through the mediating efforts of behavioral intention.

Conclusions

This study contributes to the existing literature on UTAUT2 extension of physicians’ acceptance of mHealth apps by adding altruism, cognitive trust, and online ratings. The results of this study provide a novel perspective in understanding the factors affecting physicians’ usage behaviors on mHealth apps in China and provide such apps’ managers with an insight into the promotion of physicians’ active acceptance and usage behaviors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07339-7.

Mapping Maternal Health in the New Media Environment: A Scientometric Analysis

BACKGROUND

The new media provides a convenient platform to access, use and exchange health information. And as a special group of health care, maternal health care is still of international concern due to their high mortality rate. Scientific research is a good way to provide advice on how to improve maternal health through stringent reasoning and accurate data. However, the dramatic increase of publications, the diversity of themes, and the dispersion of researchers may reduce the quality of information and increase the difficulty of selection. Thus, this study aims to analyze the research progress on maternal health under the global new media environment, exploring the current research hotspots and frontiers.

METHODS

A scientometric analysis was carried out by CiteSpace5.7.R1. In total, 2270 articles have been further analyzed to explore top countries and institutions, potential articles, research frontiers, and hotspots.

RESULTS

The publications ascended markedly, from 29 in 2008 to 472 publications by 2020. But there is still a lot of room to grow, and the growth rate does not conform to the Price's Law. Research centers concentrated in Latin America, such as the University of Toronto and the University of California. The work of Larsson M, Lagan BM and Tiedje L had high potential influence. Most of the research subjects were maternal and newborn babies, and the research frontiers were distributed in health education and psychological problems. Maternal mental health, nutrition, weight, production technology, and equipment were seemingly hotspots.

CONCLUSION

The new media has almost brought a new era for maternal health, mainly characterized by psychological qualities, healthy and reasonable physical conditions and advanced technology.

Investigating Medical Student's Preferences for Internet-Based Healthcare Services: A Best-Worst Scaling Survey

Objective: This study aimed to investigate the importance of providing Internet-based healthcare services based on the preference of a sample of medical students in China. Methods: An online best-worst scaling (BWS) survey with Case 1 design was conducted. Balanced independent block design generated 12 choice task profiles for each participant to answer. Descriptive analysis was used to describe the respondents' characteristics; Multinomial and mixed logit regression methods were used to investigate the importance of Internet-based services based on respondents' preferences. Results: A total of 1,296 students completed the online survey and rated "Clinical Service," "Decision Aids," and "Public health" as the three most important services that should be provided through an Internet-based healthcare system. Providing "Medical Education" via the Internet was chosen as the least important service by the respondents. Subgroup analysis indicated that students studying clinical medicine and non-clinical medicine considered providing "Medical Education" and "Public Health," respectively, as more important services than others. Conclusions: This BWS study demonstrated that providing "Clinical Service," "Decision Aids," and "Public Health" through the Internet are the three most important services based on medical students' preferences in China. Further research is needed to investigate how to improve medical students' skills in using internet-based healthcare services in medical education programs.

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.

Measuring online health-seeking behaviour: Construction and initial validation of a new scale

OBJECTIVES

Online health-seeking behaviour (OHSB) such as information- and support-seeking encompasses a range of motivations and outcomes, but few studies consider the nuances of OHSB. The current study aimed to (1) develop and provide an initial validation of an OHSB measure, and (2) explore the role of demographic variables in OHSB among adult Internet users.

DESIGN

The study was a quantitative, cross-sectional online survey.

METHODS

The study consistent of two data collection waves, including 451 general Internet users (aged 18-73) and 204 online health groups users (aged 19-78) who completed online questionnaires.

RESULT

Exploratory Factor Analysis and Item Analysis in the two samples resulted in a final 37-item measure. The scale comprises three distinct factors: Support seeking (α = .97); information seeking (α = .89); and the Internet as a supplement or alternative to offline medical care (α = .88). Multiple regression analyses indicated that younger age, a higher number of people living in the household, and presence of a chronic condition significantly predicted all three aspects of OHSB. Poorer perceived health also predicted support-seeking online, while being male, employed and a general Internet user (vs. online health group member) also predicted using the Internet as a supplement or alternative to offline medical care.

CONCLUSION

The study presents a useful scale for future research to explore more complex psychosocial, contextual and health-related variables as potential contributors to health-seeking in the online domain.

Online Patient Information on Domiciliary Oxygen Therapy: An Evaluation of Quality, Suitability, Reliability, Readability and Content

BACKGROUND

Domiciliary oxygen therapy (DOT) is a complex intervention and has significant impact on patients' daily activities, quality of life, and mental wellbeing. Suitable education is pertinent in improving patients' understanding and usage of DOT, as those receiving appropriate education have a better knowledge of their prescription, clearer expectations, and improved adherence to DOT.

RESEARCH QUESTION

Do currently available online patient resources on DOT provide high-quality information for patients?

STUDY DESIGN AND METHODS

We evaluated the first 100 results of three major search engines [Google, Yahoo and Bing] using the terms, "home oxygen therapy" and "information or education". Website content was assessed based on Thoracic Society of Australia and New Zealand and British Thoracic Society domiciliary oxygen guidelines. Validated tools were used to evaluate resource quality [DISCERN instrument], suitability [Suitability Assessment of Materials (SAM)], reliability [Journal of the American Medical Association (JAMA) benchmarks and the Health on the Net (HON) code], and readability [Flesch Reading Ease and Flesch-Kincaid Grade Level].

RESULTS

Thirty-six websites met study inclusion criteria. Websites from foundation/advocacy organisations scored the highest in quality and suitability, with a median DISCERN total score of 48.0 (interquartile range: 43.5-60.0) or "fair" and a median SAM suitability score of 70% (53.0-71.0) or "superior". Industry/for-profit websites had the best content score of 7.8 (5.0-8.6). The HON accreditation seal was present on 14% of the websites and only five websites met the four JAMA benchmarks. The median readability scores exceeded the recommended reading grades of 6th to 8th level for consumer health-related educational resources.

INTERPRETATION

The overall quality, suitability, reliability, and content of online health resources for DOT are of a low-to-moderate standard, with the reading grade at an unsuitable level for the general population. Health professionals should be aware of the limitations of currently available online DOT patient resources.

An analysis of the diagnostic accuracy and peer-to-peer health information provided on online health forums for heart failure

AIMS

To examine the accuracy of diagnostic responses and types of information provided on online health forums.

DESIGN

Qualitative descriptive study.

METHODS

This paper reports the findings of a thematic analysis of peer responses to posts included on heart failure online health forums, to understand the quality and types of information provided. Responses posted between March 2016 and March 2019 were screened, collected and analysed thematically using Braun & Clarke. Themes were conceptually underpinned by Normalization Process Theory. Responses were assessed for quality against the NICE and SIGN guidelines to determine whether they were evidence based or not.

RESULTS

The total number of responses collected for analysis was 639. Five main themes were identified: diagnostic, experiential, informational, peer relations and relationships with healthcare professionals. Out of 298 diagnostic responses, 5% were guideline evidence-based and 6% had information that were partly evidence-based. Non-evidence based and potentially dangerous responses were 10%. Experiential responses were 10%; 23% included advice that was not supported with any clinical evidence; and 46% signposted users to other online references/healthcare professionals.

CONCLUSION

Online health communication largely focuses on provision of experiential responses to assist those in need of pre- or post-diagnosis advice and support. However, there is evidence of inaccurate information provision which suggests the use of a moderator would be beneficial.

IMPACT

This study suggests heart failure online health forums are a source of support, however, there are potential risks. Increasing nurses and other health care professional's awareness of online health forums will be important. Additional training is needed to help them learn more about patient's use of online health forums, to gain a better understanding about the types of information sought, and how best to address such knowledge deficits. Healthcare systems must ensure sufficient time and resources are available to meet information needs for people with heart failure.

Information on the Internet about clear aligner treatment-an assessment of content, quality, and readability

Purpose

The goal was to evaluate the content, quality, and readability of the information available about clear aligner treatment on the Internet.

Materials and methods

The search terms “aligner,” “clear aligner,” and “Invisalign” (Align Technology, Tempe, AZ, USA) were analyzed in three search engines (Google [Google LLC, Mountain View, CA, USA], Bing [Microsoft, Redmond, WA, USA], and Yahoo [Yahoo, Sunnyvale, CA, USA]). The first 50 websites for each keyword in each search engine were screened. Duplicate websites, advertisements, links to scientific articles, videos, and other irrelevant websites were excluded. The quality of the remaining websites was analyzed using the DISCERN and Journal of American Medical Association (JAMA) benchmark instruments together with the Health on the Net code (HONcode, Health On the Net Foundation, Geneva, Switzerland). The readability of the websites was evaluated by the Flesch Reading Ease Score (FRES) and Flesch–Kincaid Grade Level (FKGL). Statistical analyses were performed by one-way analysis of variance, Kruskal–Wallis and Fischer’s exact tests, with p < 0.05 accepted to be statistically significant.

Results

Among 111 evaluated websites, most belonged to multidisciplinary dental clinics (n = 49; 44.2%), followed by aligner companies (n = 26; 23.4%), orthodontists (n = 26; 23.4%), and professional organizations (n = 10; 9%). The mean DISCERN score (sections 1 and 2) for all websites was 29.95/75. The average FRES and FKGL were 55.77 and 9.74, respectively. Professional organization websites had significantly higher DISCERN scores than others (p < 0.001), and together with multidisciplinary dental clinic websites, they showed better compliance with JAMA benchmark criteria. Professional organization websites’ FRES and FKGL were also higher than other websites (p > 0.05).

Conclusions

Overall, the quality of web-based information about clear aligners was poor and the readability of the data was insufficient. Websites presenting high-quality data with better readability are needed for potential aligner patients.

In the digital age: a systematic literature review of the e-health literacy and influencing factors among Chinese older adults

Aim

This study aimed to explore the current status of e-health literacy among Chinese older adults, and to summarize and analyze the related influencing factors.

Subject and methods

Following the PRISMA Checklist, we searched MEDLINE, CINAHL Complete (EBSCO), PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, and China Science and Technology Journal Database to identify the relevant literature published between January 2000 and December 2020. The Mixed Methods Assessment Tool (MMAT) was used to appraise the quality of the studies.

Results

Five articles were included for the systematic review. The results showed that the e-health literacy of Chinese older adults was low. Based on the social-ecological model, the influencing factors at the individual level included age, gender, educational attainment, socioeconomic status, physical and psychological conditions, frequency of internet use, and credibility perception of online health resources; at the interpersonal level, the influencing factors included marital status, being the family carer and being taught how to use internet to find health resources; at the social/community level, influencing factors included language barriers and cultural barriers.

Conclusion

Current e-health literacy among Chinese older adults is low, which is affected by a number of factors. Medical staff should provide detailed health information with guaranteed accuracy and reliability for elderly people. It is necessary to develop intervention programs tailored to varied educational needs of the elderly with different backgrounds (i.e., age, gender, educational attainment, and socioeconomic status) need to be developed in the near future. Family members are encouraged to teach older adults how to use e-health resource in appropriate ways.

Predictors of high trust and the role of confidence levels in seeking cancer-related information

One of the most commonly searched topics on the internet in the United States is cancer. Our study aims to provide a general overview of the predictors of trust for two health information sources, doctors and the internet, when seeking cancer-related information. The data were obtained from the 2018 HINTS 5 Cycle 2 survey, which was administered from January through May to a total of 3,504 respondents. We carried out next a series of ordinal logistic regression models to identify predictors of high trust in doctors and the internet separately for cancer-seeking information. Demographic predictor variables varied as predictors of high trust for cancer knowledge across both sources. Respondents who reported less confidence in their ability to seek cancer information had significantly higher odds of high trust in both doctors (OR = 8.43, CI: 5.58-12.73) and the internet (OR = 2.93, CI: 1.97-4.35) as compared to those who reported being "completely confident" in their ability to obtain cancer information. Understanding the key predictors of trust in doctors and the internet is crucial to the enhancement of health. The role of confidence as a predictor of trust in seeking cancer information has been shown to consistently influence the levels of trust attributed to each topic.

The influence of online health information on health decisions: A systematic review

OBJECTIVES

This systematic review assessed the influence of online health information (OHI) search behaviour on health and medical decisions.

METHODS

Eligible studies were identified by searching electronic databases PubMed, Scopus, and CINAHL in February 2020 for studies reporting OHI search behaviour and its influence on health decisions. Information was extracted pertaining to either consumers' (self-reported) perceptions of the influence of OHI on decision-making or the association between online search behaviour and health decision-making.

RESULTS

A total of 3995 articles were screened, with 48 included in the final analysis. The reviewed studies indicated that OHI assisted in making subsequent health related decisions such as asking questions during a consultation, increased professional visits, improved adherence to the advice of a physician, being more compliant with taking medication, and improved self-care.

CONCLUSION

Consumers largely used OHI to support information provided by their physicians. The strength of the patient-provider relationship was considered important in moderating the potential negative outcomes of OHI.

PRACTICE IMPLICATIONS

Health care systems have a unique opportunity to direct OHI search behaviours towards empowering consumers to engage as an informed, active and joint decision-maker in their own health care.

Information sources for patients undergoing corneal refractive surgery: results from a cross-sectional patient survey from a single private center in Pola​nd

Purpose

To identify the information sources for patients undergoing laser vision correction.

Methods

Individuals who underwent corneal refractive surgery at a private practice from December 2017 to August 2018 and agreed to complete an anonymous questionnaire were included. The manifest refraction and surgical method was recorded and correlated with the questionnaire results.

Results

Data collected from 126 patients (mean age, 32.8 ± 8.6 years; 55.6% women) were analyzed. Of 121 patients, 120 (99.2%) identified the Internet as a source for information on refractive surgery, and 71 of 119 (59.7%) noted that the clinic's website influenced their choice of clinic. Patients with high myopia more commonly used contact lenses and had considered undergoing refractive surgery for a longer time compared with patients with other refractive errors (P < 0.01 and P < 0.01, resp.). Patients with hyperopia were less likely to know their own refractive error (P = 0.02).

Conclusions

In this patient cohort, the Internet was the main source of information for those undergoing refractive surgery.

Re-Examining the Impact of Multidimensional Trust on Patients' Online Medical Consultation Service Continuance Decision

Recent years have witnessed the rapid growth of an emerging digital healthcare service - online medical consultation (OMC). Despite its popularity, many OMC platforms have encountered issues in initial adoption and continuance use among patients. We posit that many of the hesitation and resistance may arise from a lack of trust toward OMC, which is a complex phenomenon that involves both interpersonal and technological-oriented considerations. This study seeks to clarify the conceptualization of online trust in the context of OMC. It compares two plausible explanations (i.e., trust as a direct cause vs. trust as a moderator) regarding how interpersonal and technological trust contributes to the service continuance decision in OMC. By contextualizing the valence framework, we identify the critical factors in making the risk-benefit assessment of patients' OMC decision. We conduct an online survey of 365 experienced OMC users and analyze our structural model using a partial least square approach. Our results show that the multidimensional conceptualization approach, which incorporates both interpersonal and technological aspects of trust, is superior to the unitary approach. Besides, our findings suggest that the role trust plays in determining service continuance decisions in OMC is more of a direct cause than a qualifier that buffers the impacts of risk-benefit evaluation. We believe the findings can help both researchers and practitioners recognize the multidimensional perspective of trust and better understand the role trust plays in OMC and other online healthcare delivery problems.

Patient-Centered Communication Mediates the Relationship between Health Information Acquisition and Patient Trust in Physicians: A Five-Year Comparison in China

Public trust in medical profession has declined in the past decades. The deluge of health information available in various sources may be one contributing factor. However, how the health information acquisition influences patient trust remains unclear. With a general basis of Longo's Health Information Model, we proposed and tested mediation pathways linking three types of health information acquisition behaviors (scanning, seeking, and discussing) to patient trust in physicians, mediated by patient-centered communication. By using two iterations of probability sample surveys conducted in 2012 (N = 2568) and 2017 (N = 3090), respectively, in China, this study found that from 2012 to 2017, health information scanning declined. Specifically, the scanning via traditional media (e.g., newspaper, tv) decreased, but increased in the new media (e.g., Web). Besides, both health information seeking and discussing slumped. Among the three dimensions of health information acquisition, health information scanning and discussing exerted direct effects on patient trust. However, patient-centered communication was found to be mediated the relationships between all three types of health information acquisition and patient trust in physicians over time.

Impact of patient information behaviours in online health communities on patient compliance and the mediating role of patients' perceived empathy

OBJECTIVE

Patient health information seeking and physician-patient communication in OHCs proved to have impacts on patient compliance, but related studies from psychological perspectives are limited. This study aims to investigate the impact of patient health information seeking and physician-patient communication in OHCs on patient compliance.

METHODS

This study established a research model and proposed six hypotheses. An anonymous investigation was conducted using Chinese OHCs. Confirmatory factor analysis, partial least squares, and structural equation modelling were used to test the hypotheses.

RESULTS

We received 371 responses, and 316 of them were valid. Patient health information seeking and physician-patient communication frequency in OHCs had positive impacts on patients' perceived affective and cognitive empathies, which positively impacted patient compliance.

CONCLUSIONS

Patient compliance can be improved by patient health information seeking and physician-patient communication in OHCs and affective and cognitive empathies. Patients' perceived affective empathy is the preferred perspective to improve patient compliance.

PRACTICE IMPLICATIONS

Physicians should encourage patients to seek health information and communicate with them through OHCs, be concerned about patients' experiences, feelings, and attitudes, understand patients' demands and mental states, and show their patients that they can feel patients' pain. Increasing physician-patient communication frequency in OHCs can help improve patient compliance.

Rebuild doctor-patient trust in medical service delivery in China

Doctor–patient trust is not strong in China, but studies examining this factor remain insufficient. The present study aimed to explore the effect of doctor–patient communication, medical service quality, and service satisfaction on patient trust in doctors. Five hundred sixty-four patients with tuberculosis participated in this cross-sectional study in Dalian, China. They completed questionnaires assessing socio-demographic characteristics, doctor–patient communication, medical service quality, service satisfaction and patient trust in medical staff. A structural equation model was applied to examine the hypotheses, and all the study hypotheses were supported: (1) doctor–patient communication, medical service quality and service satisfaction were positively associated with building doctor–patient trust; (2) service quality positively mediated the relationship between doctor–patient communication and trust; (3) medical service satisfaction positively mediated the relationship between doctor–patient communication and trust; (4) medical service satisfaction positively mediated the relationship between medical service quality and doctor–patient trust; and (5) medical service quality and service satisfaction were the positively sequential mediators between communication and doctor–patient trust. Based on these findings, improvements in doctor–patient communication, medical service quality, and service satisfaction are the important issues contributing to the rebuilding of doctor–patient trust in medical service delivery.

User reactions to COVID-19 screening chatbots from reputable providers

OBJECTIVES

The objective was to understand how people respond to coronavirus disease 2019 (COVID-19) screening chatbots.

MATERIALS AND METHODS

We conducted an online experiment with 371 participants who viewed a COVID-19 screening session between a hotline agent (chatbot or human) and a user with mild or severe symptoms.

RESULTS

The primary factor driving user response to screening hotlines (human or chatbot) is perceptions of the agent's ability. When ability is the same, users view chatbots no differently or more positively than human agents. The primary factor driving perceptions of ability is the user's trust in the hotline provider, with a slight negative bias against chatbots' ability. Asian individuals perceived higher ability and benevolence than did White individuals.

CONCLUSIONS

Ensuring that COVID-19 screening chatbots provide high-quality service is critical but not sufficient for widespread adoption. The key is to emphasize the chatbot's ability and assure users that it delivers the same quality as human agents.

The Impact of Treatment-Related Internet Health Information Seeking on Patient Compliance

Background: Patients are increasingly using technology to seek health information, particularly on treatments. Treatment-related internet health information-seeking behavior may have impact on patients' trust in their physicians and the patient-physician relationship. Therefore, understanding the impacts of treatment-related internet health information-seeking behavior on patient-physician relationship, especially patient compliance, from the perspective of trust is important. Methods: The established research model has two independent variables (emerging and mature treatment-related internet health information seeking), two mediators (cognition- and affect-based trust), and one dependent variable (patient compliance). All variables were measured using previously validated multiple-item scales. We collected data through a web-based questionnaire survey in China and obtained 336 valid responses. The questionnaire validity rate was 89.6% (336/375), and reliability and validity were acceptable. Finally, we used confirmatory factor analysis and structural equation modeling to test the hypotheses and develop the research model. Results: Cognition- and affect-based trust had a direct positive impact on patient compliance. Cognition-based trust had a direct positive impact on affect-based trust. Mature treatment-related internet health information seeking had a significant positive impact on patient compliance through patients' cognition- and affect-based trust in their physicians. However, the emerging treatment-related internet health information seeking indicated a nonsignificant impact on patients' cognition- and affect-based trust in their physicians. Conclusions: Providing patients with access to treatment-related internet health information will not have a negative impact on the patient-physician relationship. Instead, encouraging patients to seek treatment-related health information online can improve patient compliance. Physicians can also learn much about health information related to emerging treatments to enhance their professionalism and reliability.

Talking about Dr. Google: Communication strategies used by nurse practitioners and patients with inflammatory bowel disease in the Netherlands to discuss online health information

OBJECTIVE

This study explores how patients with Inflammatory Bowel Disease (IBD) and nurse practitioners (NPs) in the Netherlands communicate about online health information-seeking.

METHODS

We analyzed 165 consultations of patients at the start of maintenance treatment using grounded theory. Consultations in which the words; internet, website, Google, Googled, webpages, online (forum/blog/platform) or a website was mentioned, were included. Segments were identified and analyzed that represented a discussion about online health information-seeking (n = 87). We coded the initiator, initiation and reaction communication strategy.

RESULTS

Half of the sample was female, most patients were moderately to highly educated and aged on average 48 years. One third of the consultations included a discussion about online health information-seeking. Seventeen communication initiation and reactions strategies were identified. Patients and NPs were equally as likely to initiate a neutral discussion about online health information-seeking. Patients repeatedly reacted with disclosing their concerns. NPs responded by taking patients' online health information-seeking seriously or affirming patients' beliefs.

CONCLUSION

This exploration makes a unique contribution by demonstrating that NPs particularly adopt a patient-centered communication style while communicating about patients' online health information-seeking.

PRACTICE IMPLICATIONS

Results of this study could guide interventions to train providers in talking about patients' online health information-seeking.

YouTube for Cosmetic Plastic Surgery: An Effective Patient Resource?

BACKGROUND

YouTube is increasingly being utilized as a major educational resource by patients. It is important for plastic surgeons to understand the quality and characteristics of videos that patients are likely to view about procedures of interest.

OBJECTIVES

The aim of this study was to evaluate the quality of the videos that patients are most likely to encounter when searching YouTube for the most common cosmetic plastic surgery procedures.

METHODS

Based on Google Trends data, the most searched medical and colloquial terms were identified for common cosmetic surgery procedures: "abdominoplasty," "tummy tuck," "breast augmentation," "boob job," "liposuction," "lipo," "mastopexy," "breast lift," "reduction mammoplasty," and "breast reduction." On YouTube, videos were searched by relevance (default) and view count; the top 10 results were collected in each group and rated according to the DISCERN criteria. Each video was assigned an overall and bias DISCERN score (DS). A score of 1 indicates high bias and low overall quality and a score of 5 indicates the opposite.

RESULTS

In total, 143 unique videos were identified, which resulted in a mean bias DS of 2.29 and mean overall DS of 2.44. Seventy-two videos included US board-certified plastic surgeons and 58 were classified as patient experience. Videos had 667,373,209 total views and were an average of 4.27 years old. Videos including US board-certified plastic surgeons were of significantly higher quality and showed lower bias than videos without these practitioners (P < 0.05).

CONCLUSIONS

Overall, YouTube videos showed high bias and low quality. Plastic surgeons should be aware of this popular resource and counsel patients about the bias that is often present. Plastic surgeons and academic plastic surgery organizations should strive to upload high-quality, unbiased videos to provide patients with a more appropriate resource.

Qualitative evaluation of paediatric surgical otolaryngology content on YouTube

OBJECTIVE

This study evaluated the quality of YouTube content focusing on common paediatric otolaryngology procedures, as this content can influence the opinions and medical decisions of patients.

METHODS

A total of 120 YouTube videos were compiled to review using the terms 'adenoid removal', 'adenoidectomy', 'ear tubes', 'tympanostomy', 'tonsil removal' and 'tonsillectomy'. The Discern criteria was used to rate the quality of health information presented in each video.

RESULTS

The mean bias Discern score was 3.18 and the mean overall Discern score was 2.39. Videos including US board certified physicians were rated significantly higher (p < 0.001) than videos without (bias Discern score = 3.00 vs 2.38; overall Discern score = 3.79 vs 1.55). The videos had been viewed a total of 176 769 549 times.

CONCLUSION

Unbiased, high quality videos on YouTube are lacking. As patients may rely on this information when making medical decisions, it is important that practitioners continually evaluate and improve this video content. Otolaryngologists should be prepared to discuss YouTube content with patients.

Exploring the Effects of Patient Activation in Online Health Communities on Patient Compliance

Background: Online health communities (OHCs) are one of the developments related to online health. Patient compliance plays a vital role in improving health treatment outcomes. Patient activation is associated with patient activities in OHCs, such as physician-patient communication and health information seeking. In other words, OHCs influence patient compliance. Therefore, identifying the relationship between patient activation in OHCs and patient compliance is important for improved health outcomes. Methods: This study established a research model consisting of one independent variable (patient activation), four mediators (physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy), one dependent variable (patient compliance) and four control variables (gender, age, education level, and status). Data were obtained through a web-based survey, involving a total of 387 valid participants in China. These data were analyzed and tested through structural equation modeling and partial least squares. Results: Patient activation positively affects patient compliance through the mediation of physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy. Perceived information asymmetry has no direct effect on patient compliance. However, perceived information asymmetry affects patient compliance through the mediation of e-health literacy. Conclusions: Patient compliance is significantly affected by patient activation. Thus, physicians can achieve higher patient compliance by improving patient activation. Guaranteeing and improving the information quality in OHCs is essential for physicians and OHCs operators. Physicians should pay extra attention in cultivating patients' e-health literacy through communications and health information-seeking behaviors to further improve patient compliance.