Health Information Obtained From the Internet and Changes in Medical Decision Making: Questionnaire Development and Cross-Sectional Survey

Quality and Readability of Online Educational Mohs Micrographic Surgery Resources

BACKGROUND

As internet access continues to expand, online health care information is increasingly influencing patient decisions. Mohs micrographic surgery (MMS) is commonly used in the field of dermatology but may be unfamiliar to many patients.

OBJECTIVE

The purpose of this study was to identify and analyze online educational resources regarding MMS and learn how to optimize the understanding and informational content of MMS for patients and their families.

MATERIALS AND METHODS

Thirty-two websites were evaluated for authorship, quality, and readability using DISCERN, JAMA Benchmark Criteria, and Flesch-Kincaid tests.

RESULTS

Physician-authored content showed a trend toward higher quality ( p = .058). Google scored higher in specific DISCERN questions when overlapping websites were excluded. Bing scored higher in JAMA criteria ( p = .03) in criteria such as authorship and currency. Higher DISCERN scores correlated with lower readability.

CONCLUSION

Physician involvement improves content quality, raising questions about physicians' responsibility in online resource creation. Correlations between content quality and readability highlight potential challenges for certain demographics. Balancing medical accuracy with comprehensibility is crucial for equitable patient education. This study underscores the need to refine online resources, ensuring accurate, transparent, and accessible health care information.

Characterizing the Online Discourse on Facial Paralysis: What Patients Are Asking and Where They Find Answers

Background: With the rising popularity of online search tools, patients seeking information on facial palsy are increasingly turning to the Internet for medical knowledge. Objective: To categorize the most common online questions about Bell's palsy or facial paralysis and the sources that provide answers to those queries. Methods: Query volumes for terms pertaining to facial palsy were obtained using Google Search trends. The top 40 keywords associated with the terms "Bell's palsy" and "facial paralysis" were extracted. People Also Ask (PAA) Questions-a Google search engine response page feature-were used to identify the top questions associated with each keyword. Results: A total of 151 PAA Questions pertaining to the top 40 keywords associated with "Bell's palsy" and "facial paralysis" were identified. Etiology questions were most frequent (n = 50, 33.1%), meanwhile those pertaining to treatment were most accessible (119.5 average search engine response pages/question, 35.5%). Most sources were academic (n = 81, 53.6%). Medical practice group sites were most accessible (211.9 average search engine response pages/website, 44.8%). Conclusion: Most PAA questions pertained to etiology and were sourced by academic sites. Questions regarding treatment and medical practice sites appeared on more search engine response pages when compared with all other categories.

Validation of the extended e-health literacy scale: structural validity, construct validity and measurement invariance

BACKGROUND

Given the rapid proliferation and use of online health resources, many of which may be of dubious quality, there is an increasing need to develop electronic health literacy (e-health literacy) skills among the population of internet users. E-health literacy encompasses the skills and abilities needed to access, understand, validate, evaluate, interpret, and apply online health-related information. Measuring e-health literacy has become crucial for developing targeted interventions, assessing their impact, and producing high-quality research findings that can inform health policy and clinical practice, which can lead to improved health outcomes and potentially reducing health inequalities. The scales need to be valid and reliable so that decisions are based on high-quality data. In this regard, the issue of the measurement invariance of scales across different demographic groups has been neglected. This is critical, as assessments should be valid across different sociodemographic groups to avoid bias when comparing them. The aim of this study was to validate the Extended e-health literacy scale (eHEALS-E) on general population and investigate its structural validity and internal consistency, construct validity in terms of convergent and discriminant validity, and examine its measurement invariance across gender, age, education and social status.

METHODS

The data were collected as a part of a national health literacy survey conducted by the Slovenian National Institute of Public Health. For this survey the initial eHEALS-E scale was revised in order to address its limitations and applicability to general population. Based on a nationally representative sample, the final sample for the analysis comprised 1,944 individuals who at least occasionally used one of the various internet services to obtain health-related information. Multiple group confirmatory factor analysis was used to examine the measurement invariance of the scale.

RESULTS

With some adjustments, the measurement model of the revised 6-dimensional eHEALS-E scale demonstrated a good fit to the data (χ2 = 2508, df = 282, RMSEA = 0.064, SRMR = 0.070, CFI = 0.90). The scale had good internal consistency (alpha = 0.89). Although evidence of the scale's convergent and discriminant validity was partially provided, the analysis revealed robust measurement invariance across sociodemographic groups.

CONCLUSIONS

With a minor limitation, the scale ensures an unbiased e-health literacy assessment across different social groups, which is crucial for interventions that aim to reduce health-related social inequalities. This ensures that the interventions derived from the assessment of reality are equally valid and effective for everyone, regardless of their sociodemographic background.

Understanding search autocompletes from the perspectives of English and Spanish speakers during the early months of the COVID-19 pandemic

The purpose of the study was to explore differences in Google search autocompletes between English and Spanish-speaking users during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. Twenty-nine individuals who were in areas with shelter-in-place state orders participated in a virtual focus group meeting to understand the algorithm bias of COVID-19 Google autocompletes. The three focus group meetings lasted for 90-120 minutes. A codebook was created and transcripts were coded using NVivo qualitative software with a 95% intercoder reliability between two coders. Thematic analysis was used to analyze the data. Among the 29 participants, six self-identified as White, seven as Black/African American, five as American Indian or Alaska Native, four as Asian Indian, and three as Native Hawaiian or Pacific Islander. In terms of ethnicity, 21 participants identified as Hispanic/Latino. The themes that emerged from the study were: (1) autocompletes evoked fear and stress; (2) skepticism and hesitation towards autocomplete search; (3) familiarity with COVID-19 information impacts outlook on autocomplete search; (4) autocompletes can promote preselection of searches; and (5) lesser choice of autocomplete results for Spanish-speaking searchers. Spanish speakers expressed concerns and hesitation due to social factors and lack of information about COVID-19.

Impact of mobile Internet use on health-seeking behaviors: evidence from China

Introduction

Although health-seeking behaviors are crucial to China's healthcare delivery system, the influence of mobile Internet use in this context remains under-explored. This study aimed to comprehensively explore the influence of mobile Internet use on health-seeking behaviors, and meticulously examined the heterogeneity in health outcomes associated with the intersection between mobile Internet use and health-seeking behaviors.

Methods

We used nationally representative data derived from the China Family Panel Studies. Given that individuals typically make the decision to use mobile Internet autonomously, an instrumental variable regression methodology was adopted to mitigate potential selection biases.

Results

Our findings revealed that mobile Internet use significantly promoted self-medication and adversely affected the use of primary care facilities among Chinese adults. Furthermore, our findings highlighted the heterogeneous effects of mobile Internet use across diverse health demographic groups.

Conclusion

These findings underscore the importance of strategic planning and utilizing mobile Internet resources to steer individuals toward more appropriate healthcare-seeking behaviors.

Structural and social factors affecting COVID-19 vaccine uptake among healthcare workers and older people in Uganda: A qualitative analysis

The COVID-19 vaccine rollout programme in Uganda was launched in March 2021 for priority groups: Healthcare Workers (HCWs), older persons (≥50 years), and persons with chronic conditions. Misinformation, distrust in healthcare systems, and cultural beliefs, pose significant challenges to vaccine uptake. We describe the social and structural factors affecting the uptake of COVID-19 vaccines among HCWs and older people in Uganda. Between September and October 2021, we conducted 33 in-depth interviews with 25 HCWs aged 21-63 years from three hospitals in central Uganda and eight older people from Wakiso district. Participant selection was purposive, based on sex, occupation, education, cadre of HCWs and vaccination status. We explored participants' knowledge, beliefs, personal experiences, barriers, and facilitators to vaccine uptake as well as suggestions for future COVID-19 vaccine rollout. Interviews were audio-recorded, transcribed and translated into English, coded, and analysed by theme. Twenty-two of the 25 (88%) HCWs and 3 of the 8 (38%) older people had received at least one dose of the COVID-19 vaccine at the time of interview. The structural facilitating factors to vaccine uptake included access to correct information, fear of a risky work environment, and mandatory vaccination requirements especially for frontline HCWs. Age, chronic health conditions, and the fear of death were facilitating factors for older people. Misconceptions about COVID-19 vaccines and fear of side effects were common social barriers for both groups. Long distances to vaccination centres, vaccine stock-outs, and long queues at the vaccination centres were specific barriers for older people. The prerequisite of signing a consent form was a specific structural barrier for HCWs. Future roll out of new vaccines should have a comprehensive information dissemination strategy about the vaccines. Improved access to vaccines through community outreach, reliable vaccine supplies and addressing vaccine misinformation, may enhance COVID-19 vaccine uptake.

Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey

OBJECTIVE

Develop a process map of when patients learn about their proposed surgery and what resources patients use to educate themselves.

DESIGN

A mixed methods design, combining semistructured stakeholder interviews, quantitative validation using electronic healthcare records (EHR) in a retrospective cohort and a cross-sectional patient survey.

SETTING

A single surgical centre in the UK.

PARTICIPANTS

Fourteen members of the spinal multidisciplinary team were interviewed to develop the process map.This process map was validated using the EHR of 50 patients undergoing elective spine surgery between January and June 2022. Postprocedure, feedback was gathered from 25 patient surveys to identify which resources they used to learn about their spinal procedure. Patients below the age of 18 or who received emergency surgery were excluded.

INTERVENTIONS

Elective spine surgery and patient questionnaires given postoperatively either on the ward or in follow-up clinic.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the percentage of the study cohort that was present at encounters on the process map. Key timepoints were defined if >80% of patients were present. The secondary outcome was the percentage of the study cohort that used educational resources listed in the patient questionnaire.

RESULTS

There were 342 encounters which occurred across the cohort, with 16 discrete event categories identified. The initial surgical clinic (88%), anaesthetic preoperative assessment (96%) and admission for surgery (100%) were identified as key timepoints. Surveys identified that patients most used verbal information from their surgeon (100%) followed by written information from their surgeon (52%) and the internet (40%) to learn about their surgery.

CONCLUSIONS

Process mapping is an effective method of illustrating the patient pathway. The initial surgical clinic, anaesthetic preoperative assessment and surgical admission are key timepoints where patients receive information. This has future implications for guiding patient education interventions to focus at key timepoints.

Developing a Tool for Assessing the Process of Seeking Health Information: Online Think-Aloud Method

Nursing students can access massive amounts of online health data to drive cutting-edge evidence-based practice in clinical placement, to bridge the theory-practice gap. This activity requires investigation to identify the strategies nursing students apply to evaluate online health information. Online Think-Aloud sessions enabled 14 participants to express their cognitive processes in navigating various educational resources, including online journals and databases, and determining the reliability of sources, indicating their strategies for information-seeking, which helped to create this scoring system. Easy access and user convenience were clearly the instrumental factors in this behavior, which has troubling implications for the lack of use of higher-quality resources (e.g., from peer-reviewed academic journals). The identified challenges encountered during resource access included limited skills in the critical evaluation of information credibility and reliability, signaling a requirement for improved information literacy skills. Participants acknowledged the importance of evidence-based, high-quality information, but faced numerous barriers, such as restricted access to professional and specialty databases, and a lack of academic skills training. This paper develops and critiques a Performative Tool for assessing the process of seeking health information using an online Think-Aloud method, and explores factors and strategies contributing to evidence-based health information access and utilization in clinical practice, aiming to provide insight into individuals' information-seeking behaviors in online health contexts.

How artificial intelligence can provide information about subdural hematoma: Assessment of readability, reliability, and quality of ChatGPT, BARD, and perplexity responses

Subdural hematoma is defined as blood collection in the subdural space between the dura mater and arachnoid. Subdural hematoma is a condition that neurosurgeons frequently encounter and has acute, subacute and chronic forms. The incidence in adults is reported to be 1.72-20.60/100.000 people annually. Our study aimed to evaluate the quality, reliability and readability of the answers to questions asked to ChatGPT, Bard, and perplexity about "Subdural Hematoma." In this observational and cross-sectional study, we asked ChatGPT, Bard, and perplexity to provide the 100 most frequently asked questions about "Subdural Hematoma" separately. Responses from both chatbots were analyzed separately for readability, quality, reliability and adequacy. When the median readability scores of ChatGPT, Bard, and perplexity answers were compared with the sixth-grade reading level, a statistically significant difference was observed in all formulas (P < .001). All 3 chatbot responses were found to be difficult to read. Bard responses were more readable than ChatGPT's (P < .001) and perplexity's (P < .001) responses for all scores evaluated. Although there were differences between the results of the evaluated calculators, perplexity's answers were determined to be more readable than ChatGPT's answers (P < .05). Bard answers were determined to have the best GQS scores (P < .001). Perplexity responses had the best Journal of American Medical Association and modified DISCERN scores (P < .001). ChatGPT, Bard, and perplexity's current capabilities are inadequate in terms of quality and readability of "Subdural Hematoma" related text content. The readability standard for patient education materials as determined by the American Medical Association, National Institutes of Health, and the United States Department of Health and Human Services is at or below grade 6. The readability levels of the responses of artificial intelligence applications such as ChatGPT, Bard, and perplexity are significantly higher than the recommended 6th grade level.

Examining Healthcare Professionals' Communication Around Decision-Making with Internet-Informed Patients

In the last ten years the use of the internet as a health resource has transformed, and while patients increasingly consult online resources for health decision-making, less is known about how healthcare professionals (HCPs) currently discuss decision-making with internet informed patients (IIPs). In this paper we examine how HCPs perceive IIPs and specifically how bringing online information into appointments can prompt different communicative strategies around decision-making. Ten HCPs with experience working across different healthcare roles, took part in semi-structured interviews and discussed their interactions with IIPs around decision-making. Vignettes based on descriptions of real patients bringing online health information to their HCPs were used to prompt further discussion. The analysis identified two themes in relation to communication: (i) being honest about information sources and (ii) from compliance to co-construction: improving communication around decision-making. HCPs were overwhelmingly positive toward IIPs and encouraged patients to be transparent about their online searching to understand their motivations, priorities, and concerns. Although compliance remains part of the narrative, HCPs recognized practical ways in which discussing online health information could improve HCP-patient communication around shared decision-making. We discuss the findings in relation to early work on communicative strategies between HCP's and patients bringing resources to their consultations. We argue that for HCPs the concept of the internet as a provider of health information is no longer seen as inherently damaging or risky. There is growing acceptance of pre-consultation internet searching with the caveat that any information sourced online should inform rather than dictate decision-making with HCPs.

Are They Important? Patients' Communication Barriers to Discussing Online Health Information During Consultations

A minority of the patients who search for online health information report discussing or having an intention to discuss this information with their healthcare provider. Not discussing online health information inhibits the provision of patient-centered care and limits the healthcare provider's possibility to tackle misinformation. Within the confines of the linguistic model of patient participation, we first provide an overview of barriers to discussing online health information during consultations. Second, we pinpoint which of these barriers indicate a need for improvement. Participants from the Netherlands (N = 300) completed a survey that measured the communication barriers (N = 15) as identified based on previous literature and interviews. Using the QUality Of Care Through the patient's Eyes (QUOTE) approach, we measured the extent to which a specific factor was a barrier ("importance") and assessed whether the barrier would withhold patients from discussing online health information ("performance"). Scores on importance and performance were multiplied to identify which barriers show the most significant room for improvement. Especially "preferring to discuss other matters" often occurred. Nine barriers showed a moderate need for improvement. We discuss the implications of these findings for healthcare providers in consultations. Future research should include observational data to analyze communication barriers to discussing online health information in consultations.

Online Health Information-Seeking Behaviour among People of African Descent in the United Kingdom: A Qualitative Study

Effective public health interventions rely on understanding how individuals access, interpret, and utilise health information. Studying the health information-seeking behaviour (HISB) of a community can provide valuable insights to inform strategies that address community health needs and challenges. This study explored the online HISBs of People of African Descent (PoAD) in the United Kingdom (UK), a demographic that comprises four percent of the UK population and has a 92.8% active Internet usage rate. Data on the HISB were collected from 21 PoAD across various UK regions through online semi-structured interviews before being analysed using reflexive Thematic Analysis (TA). The participants ranged in age from 20 to 70 years and had a mean age of 42.8 (SD ± 11.4). Our analysis of the interview transcripts revealed five key themes: Internet usage and preferences, attitudes toward social media, barriers to seeking health information online, trust in online health information, and cultural influences on online HISB. Our findings indicate a proactive engagement among PoAD in seeking health information online that is underscored by a preference for professional sources over ethnic congruence. However, concerns about misinformation exist, and there are barriers to accessing health information online, including data privacy, unreliable information, and information relevance and overload. We also found that cultural factors and traditional beliefs impact the adoption of Internet-based interventions among PoAD, highlighting the need for culturally sensitive approaches. Preferences regarding the frequency and delivery of online health information varied among participants, with a majority preferring a weekly update. This study emphasises the critical need for accessible, culturally appropriate, secure, and reliable online health resources tailored to the needs and preferences of the PoAD.

Waiting to start abortion: A qualitative exploration of narratives of waiting shared in a Reddit community for abortion post-Dobbs leak in 2022

With the Dobbs leak introducing uncertainty about access and the Dobbs v. Jackson Women's Health Organization decision in June of 2022 overturning the US constitutional right to abortion, delays in accessing desired abortion care are likely growing longer and more common. Timely research on people's experiences waiting to access abortion care is needed. Using data from an abortion subreddit (r/abortion), we analyzed posts that described waiting after having decided to terminate the pregnancy, either by having an in-clinic appointment or ordering medication(s) online for self-managed abortion. Our analysis explored described 1) wait time length, 2) factors contributing to waiting, and 3) impacts of waiting. We used a hybrid inductive and deductive thematic qualitative coding approach to analyze a month-stratified 10% random sample of posts to the r/abortion community in 2022 surrounding the Dobbs leak and decision (May-December, n = 523 posts). Among posts to r/abortion that described waiting to start an abortion (n = 80), wait times ranged from one day to more than a month. Lack of appointment availability and waiting for mailed medications were commonly described as causing delays in accessing in-clinic abortion care and self-managed abortion, respectively. People shared challenges with pregnancy symptoms and feelings of anxiety, fear, isolation, and uncertainty. Posters also commonly described needing additional support while waiting. Overall, waiting to start an abortion was extremely stressful and isolating., with people often waiting weeks between ordering medication or scheduling an appointment and initiating the abortion process. Experiences of waiting to start an abortion and their impacts are of increasing concern as abortion access is further restricted. Additional targeted information and support are needed to mitigate these challenges. Providing timely access is imperative to quality care and overall abortion experiences.

Online Health Information Seeking and Preventative Health Actions: Cross-Generational Online Survey Study

BACKGROUND

The popularity of online health information seeking (OHIS) has increased significantly owing to its accessibility and affordability. To facilitate better health management, it is essential to comprehend the generational differences in OHIS behavior and preventative health actions after seeking online health information (OHI).

OBJECTIVE

This study investigates the variations in OHIS and engagement in preventative health actions between 2 generations based on their technology use (digital natives [aged 18-42 years] and digital immigrants [aged ≥43 years]). Additionally, this research explores the mediating role of OHIS types on the generational effect on preventative health actions and the moderating role of OHI search frequency, gender, and the presence of chronic diseases on the generational effect on OHIS types and preventative health actions.

METHODS

A preregistered online survey was conducted on the Prolific online data collection platform using stratified sampling of 2 generations (digital natives and digital immigrants) from the United States in November 2023. Overall, 3 types of OHIS were collected: health wellness information search, health guidance information search, and health management information search. A 1-way analysis of covariance tested the generational differences in types of OHIS and preventative health actions, and a 2-way analysis of covariance tested the moderating role of OHIS search frequency, gender, and the presence of chronic diseases using 7 control variables. The PROCESS Macro Model 4 was used to conduct mediation analyses, testing OHI search types as mediators. Linear regression analyses tested age as a predictor of OHIS and preventative health actions.

RESULTS

The analysis of 1137 responses revealed generational differences in OHIS. Digital natives searched for health wellness information more frequently (P<.001), whereas digital immigrants searched for health guidance (P<.001) and health management information (P=.001) more frequently. There were no significant differences between the 2 generations regarding preventative health actions (P=.85). Moreover, all 3 types of OHIS mediated the relationship between generational differences and preventative health actions. Furthermore, as people aged, they searched for significantly less health wellness information (P<.001) and more health guidance (P<.001), and health management information (P=.003). Age was not a significant predictor of preventative health actions (P=.48). The frequency of OHI searches did not moderate the effect of generations on OHIS types and preventative health actions. Gender only moderated the relationship between generation and health guidance information search (P=.02), and chronic diseases only moderated the relationship between generation and health wellness information search (P=.03).

CONCLUSIONS

To the best of our knowledge, this study is the first to explore how 2 digital generations vary in terms of searching for OHI and preventative health behaviors. As the older adult population grows, it is crucial to understand their OHIS behavior and how they engage in preventative health actions to enhance their quality of life.

Quality assessment of online patient information on upper gastrointestinal endoscopy using the modified Ensuring Quality Information for Patients tool

INTRODUCTION

Websites and online resources are increasingly becoming patients' main source of healthcare information. It is paramount that high quality information is available online to enhance patient education and improve clinical outcomes. Upper gastrointestinal (UGI) endoscopy is the gold standard investigation for UGI symptoms and yet little is known regarding the quality of patient orientated websites. The aim of this study was to assess the quality of online patient information on UGI endoscopy using the modified Ensuring Quality Information for Patients (EQIP) tool.

METHODS

Ten search terms were employed to conduct a systematic review. for each term, the top 100 websites identified via a Google search were assessed using the modified EQIP tool. High scoring websites underwent further analysis. Websites intended for professional use by clinicians as well as those containing video or marketing content were excluded.

FINDINGS

A total of 378 websites were eligible for analysis. The median modified EQIP score for UGI endoscopy was 18/36 (interquartile range: 14-21). The median EQIP scores for the content, identification and structure domains were 8/18, 1/6 and 9/12 respectively. Higher modified EQIP scores were obtained for websites produced by government departments and National Health Service hospitals (p=0.007). Complication rates were documented in only a fifth (20.4%) of websites. High scoring websites were significantly more likely to provide balanced information on risks and benefits (94.6% vs 34.4%, p<0.001).

CONCLUSIONS

There is an immediate need to improve the quality of online patient information regarding UGI endoscopy. The currently available resources provide minimal information on the risks associated with the procedure, potentially hindering patients' ability to make informed healthcare decisions.

Characteristics and associated factors of health information-seeking behaviour among patients with inflammatory bowel disease in the digital era: a scoping review

BACKGROUND

Health Information-Seeking Behaviour (HISB) is necessary for self-management and medical decision-making among patients with inflammatory bowel disease (IBD). With the advancement of information technology, health information needs and seeking are reshaped among patients with IBD. This scoping review aims to gain a comprehensive understanding of HISB of people with IBD in the digital age.

METHODS

This scoping review adhered to Arksey and O'Malley's framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews frameworks (PRISMA-ScR). A comprehensive literature search was conducted in PubMed, Embase, Web of Science, PsycINFO, CINAHL, and three Chinese databases from January 1, 2010 to April 10, 2023. Employing both deductive and inductive content analysis, we scrutinized studies using Wilson's model.

RESULTS

In total, 56 articles were selected. Within the information dimension of HISB among patients with IBD, treatment-related information, particularly medication-related information, was identified as the most critical information need. Other information requirements included basic IBD-related information, daily life and self-management, sexual and reproductive health, and other needs. In the sources dimension, of the eight common sources of information, the internet was the most frequently mentioned source of information, while face-to-face communication with healthcare professionals was the preferred source. Associated factors were categorized into six categories: demographic characteristics, psychological aspects, role-related or interpersonal traits, environmental aspects, source-related characteristics, and disease-related factors. Moreover, the results showed five types of HISB among people with IBD, including active searching, ongoing searching, passive attention, passive searching, and avoid seeking. Notably, active searching, especially social information seeking, appeared to be the predominant common type of HISB among people with IBD in the digital era.

CONCLUSION

Information needs and sources for patients with IBD exhibit variability, and their health information-seeking behaviour is influenced by a combination of diverse factors, including resource-related and individual factors. Future research should focus on the longitudinal changes in HISB among patients with IBD. Moreover, efforts should be made to develop information resources that are both convenient and provide credible information services, although the development of such resources requires further investigation and evaluation.

Ethnic Disparities in Patient-Centered Communication with Healthcare Providers: A Comparison of Non-Hispanic Asians and Non-Hispanic Whites

BACKGROUND

Patient-centered communication (PCC) is an important metric related to patient health outcomes. Non-Hispanic Asian (NHA) individuals reported lower PCC scores with healthcare providers than individuals of other races and ethnicities. We aim to determine the ethnic disparities in PCC and further investigate the association between PCC, individual's confidence in obtaining health-related information (health literacy), and confidence in taking care of themselves (health self-efficacy) among NHA in comparison to the Non-Hispanic White (NHW) population.

METHODS

This is a cross-sectional study. We used data from the Health Information National Trends Survey 5 (HINTS) cycles 1 and 3. PCC was measured using seven validated survey questions with scores ranging from 7 to 28. Individuals' health literacy and self-efficacy were accessed using two-item survey questions. Multivariable logistic regression analyses were performed to determine the association of independent factors (e.g., self-efficacy, health literacy, and race and ethnicity) with PCC.

RESULTS

We included 3,831 participants. Fewer NHAs (35.43%) reported high PCC scores compared to NHWs (48.99%, p = 0.0184). In fully adjusted logistic regression model, although NHAs were less likely to have high PCC scores (aOR = 0.78, 95% CI 0.46-1.32) compared to NHWs, the association was not statistically significant (p = 0.350). However, the aOR of confidence in self-efficacy associated with high PCC scores was 2.27 (95% CI 1.68-3.07, p < 0.001) and the aOR of confidence in health literacy with high PCC scores was 2.13 (95% CI 1.64-2.76, p < 0.001).

CONCLUSIONS

High PCC scores reported by NHA were not significantly different from those of NHW individuals in adjusted comparisons. Individual's confidence in self-efficacy and health literacy was positively associated with high PCC regardless of race and ethnicity.

Online health information behaviour and its association with statin adherence in patients with high cardiovascular risk: A prospective cohort study

Objective

Statins are effective for preventing cardiovascular disease. However, many patients decide not to take statins because of negative influences, such as online misinformation. Online health information may affect decisions on medication adherence, but measuring it is challenging. This study aimed to examine the associations between online health information behaviour and statin adherence in patients with high cardiovascular risk.

Methods

A prospective cohort study involving 233 patients with high cardiovascular risk was conducted at a primary care clinic in Malaysia. Participants used a digital information diary tool to record online health information they encountered for 2 months and completed a questionnaire about statin necessity, concerns and adherence at the end of the observation period. Data were analysed using structural equation modelling.

Results

The results showed that 55.8% (130 of 233 patients) encountered online health information. Patients who actively sought online health information (91 of 233 patients) had higher concerns about statin use (β = 0.323, p = 0.023). Participants with higher concern about statin use were also more likely to be non-adherent (β = -0.337, p < 0.001). Patients who actively sought online health information were more likely to have lower statin adherence, mediated by higher concerns about statin use (indirect effect, β = -0.109, p = 0.048).

Conclusions

Our results suggest that patients with higher levels of concern about statins may be actively seeking online information about statins, and their concerns might influence how they search, what they find, and the potential to encounter misinformation. Our study highlights the importance of addressing patients' concerns about medications to improve adherence.

Upper Limb Spasticity: The Quality of Online Patient Resources

OBJECTIVE

The aim of the study is to assess the quality, readability, content, accessibility, and structure of online resources for patients with upper limb spasticity.

DESIGN

This was a cross sectional study examined Internet searches across three search engines related to patient resources for upper limb spasticity. Search phrases for either hand or upper limb spasticity were used. The top 20 Websites from each search were evaluated using the four readability metrics and the DISCERN scale for quality assessment. YouTube videos with exact search phrases were evaluated using DISCERN. Descriptive statistical analyses were performed using SPSS software.

RESULTS

Thirty-six Websites and 33 videos met the inclusion criteria for this study. The average Flesh-Kincaid Grade Level of the Websites was 11.7 ± 3.1, showing low Website readability. According to this index, only two Websites were written at the suggested sixth-grade level (5.4%). With a maximum score of 75, the mean DISCERN score for both Websites and videos scored in the "good" range (53.5 ± 8 and 50.5 ± 6.6), respectively.

CONCLUSIONS

Current online resources for upper limb spasticity are good in quality but are written above the health literacy level of American citizens. Organizations should consider reviewing their present materials and developing high-quality patient education materials that are easier to understand.

Evaluating the understandability and actionability of online CKD educational materials

BACKGROUND

Previous studies have not fully determined whether online education materials on chronic kidney disease (CKD) for Japanese patients are easy to understand and help change their behavior. Therefore, this study quantitatively assessed the understandability and actionability of online CKD education materials.

METHODS

In September 2021, we searched Google and Yahoo Japan using the keywords "kidney," "kidney disease," "CKD," "chronic kidney disease," and "renal failure" to identify 538 webpages. We used the Japanese version of the Patient Education Materials Assessment Tool (PEMAT), ranging from 0 to 100%, to evaluate the understandability and actionability of webpages. We set the cutoff point to 70%.

RESULTS

Of the 186 materials included, the overall understandability and actionability were 61.5% (± 16.3%) and 38.7% (± 30.6%), respectively. The materials were highly technical in their terminology and lacked clear and concise charts and illustrations to encourage action. Compared to lifestyle modification materials on CKD overview, symptoms/signs, examination, and treatment scored significantly lower on the PEMAT. In addition, the materials produced by medical institutions and academic organizations scored significantly lower than those produced by for-profit companies.

CONCLUSION

Medical institutions and academic organizations are encouraged to use plain language and to attach explanations of medical terms when preparing materials for patients. They are also expected to improve visual aids to promote healthy behaviors.

e-Health literacy and online health information utilization among Jordanians: A population-based study

Background

The internet has become an essential part of empowering people to access health-related information. Huge amounts of health-related information are available online, but few people have the skills to assess its validity and reliability. Accordingly, the concept of ehealth literacy competencies emerged to measure the skills necessary to validate such information. As a result, the purpose of this study was to assess Jordanian people's e-health literacy, online health information utilization, and associated factors.

Methods

This population-based cross-sectional study was conducted from March to December 2023.

Results

Results: The study found that participants rated their e-health literacy at 28.94 out of 40, indicating a sufficient level of health literacy, and their online health information utilization at 39.62, indicating a high level of engagement with online health resources. Furthermore, it is revealed that e-health literacy is associated with gender and geographic region, whereas online health information utilization is associated only with chronic disease.

Conclusion

In Jordan, there is a balance between traditional and online health information use. While healthcare providers and primary health centers are the main sources of information, Jordanians show a sufficient level of e-health literacy, with females and the capital region exhibiting higher levels. Furthermore, Jordanians were more likely to use online health information. Nevertheless, it is crucial to work on improving internet platforms to enhance the quality of online health-related information.

Internet research of utilization of social media in patients with urological disease and their families in Japan

OBJECTIVES

To survey the utilization of social media (SoMe) in patients with urological disease and their families.

METHODS

Among the panel members registered in NEO Marketing Inc. (Tokyo, Japan), 300 people who or whose families were visiting the urological department regularly were included. Study subjects were randomly chosen and surveyed using the questionnaire over the internet.

RESULTS

This study included 203 (68%) males and 97 (32%) females. The mean age was 62 (21-85) in males and 49 (22-75) in females. One hundred and ten subjects (37%) had no account for any SoMe. The account holders of YouTube, Twitter, Facebook, Instagram, and TikTok were 119 (40%), 117 (39%), 101 (34%), 90 (30%), and 33 (11%), respectively. The proportions of account holders were different depending on gender, age, and platforms. Frequent viewers on YouTube, Twitter, Facebook, Instagram, and TikTok were 100 (84%), 89 (76%), 63 (62%), 66 (73%), and 24 (73%), respectively. Of 190 who had accounts for any SoMes, 64 (34%) found any information about urological diseases of themselves or their families. Among the all subjects, 162 (54%) thought that they would like to view the medical contents on SoMes submitted by medical societies.

CONCLUSIONS

Patients with urological disease and their families in Japan occasionally utilize SoMe to obtain information on their diseases and prefer professional medical information on SoMe. The gender and age of SoMe users and the optimal platform should be considered when posting medical information on SoMe.

Perceptions of conflicting information about long-term medications: a qualitative in-depth interview study of patients with chronic diseases in the Swiss ambulatory care system

OBJECTIVE

Patients with multiple long-term conditions visit various healthcare professionals and are exposed to medication information from various sources causing an increased risk of patients perceiving contradictory medication information. The aims of this study are to: (1) characterise conflicting medication information perceived by patients with long-term conditions, (2) better understand the related impact on patients' medication self-management and healthcare system navigation and (3) explore ways in which such events could be prevented.

DESIGN

This study was conducted through qualitative semistructured interviews. Data were analysed using thematic analysis.

SETTING

Community pharmacies and medical centres in Geneva, Switzerland.

PARTICIPANTS

This study included outpatients from April 2019 to February 2020. Patients were included after participating in a quantitative survey of perceived conflicting information about medications for long-term diseases.

METHODS

Semistructured audiotaped interviews of 20 to 60 min following a pre-established interview guide to explore participants' perceptions of conflicting information. Interviews were transcribed verbatim, and a thematic analysis was conducted with inductive and deductive coding using MAXQDA (2018, Release 18.2.3).

RESULTS

Twenty-two patients were interviewed, until data saturation, mentioning indication or need for a medication as the main topic of conflicting information between two healthcare professionals. Perceived conflicting information often resulted from insufficient information provided and poor communication leading to confusion, doubts and medication non-adherence. Patients expected more information and more interprofessional communication on their medications. As a result of conflicting information, most participants learnt or were learning to take an active role and become partners of the healthcare providers.

CONCLUSION

The need to strengthen and improve communication and interprofessional collaborative practice among healthcare professionals and with the patient is emerging to increase the quality and consistency of information about medications, and consequently, to ensure better use and experience of medications.

Evaluating the understandability and actionability of online educational videos on pre-dialysis chronic kidney disease

AIM

It remains undetermined whether online education videos for Japanese patients with chronic kidney disease (CKD) are easy to understand and allow adoption of behavioural changes. This study quantitatively assessed the understandability and applicability of online education videos for patients with CKD.

METHODS

In September 2021, we identified 200 videos on YouTube using the Japanese translations of the keywords 'kidney,' 'kidney disease,' 'CKD,' and 'chronic kidney disease.' We used the Japanese version of the Patient Education Materials Assessment Tool to evaluate the understandability and usability of webpages on a scale of 0% to 100%. The cut-off was set at 70%.

RESULTS

A total of 54 videos were evaluated. The overall understandability and actionability of the materials were 57.6 (SD = 22.6) and 53.7 (SD = 33.4), respectively. Approximately 70% and 60% of the materials were considered insufficiently understandable and actionable, respectively. Most videos lacked a summary and had difficulty in using only everyday language. Most videos included at least one action for the audience to take. However, many failed to break down the action into sequential steps. They also lack visual aids to encourage the audience to take action.

CONCLUSION

Our results suggest that current information on pre-dialysis chronic kidney disease was not presented in a manner that can be applied by laypeople.

Mapping the scientific research on integrated care: a bibliometric and social network analysis

Background

Integrated care (IC) is the cornerstone of the sustainable development of the medical and health system. A thorough examination of the existing scientific literature on IC is essential for assessing the present state of knowledge on this subject. This review seeks to offer an overview of evidence-based knowledge, pinpoint existing knowledge gaps related to IC, and identify areas requiring further research.

Methods

Data were retrieved from the Web of Science Core Collection, from 2010 to 2020. Bibliometrics and social network analysis were used to explore and map the knowledge structure, research hotspots, development status, academic groups and future development trends of IC.

Results

A total of 7,501 articles were obtained. The number of publications on IC was rising in general. Healthcare science services were the most common topics. The United States contributed the highest number of articles. The level of collaboration between countries and between authors was found to be relatively low. The keywords were stratified into four clusters: IC, depression, integrative medicine, and primary health care. In recent years, complementary medicine has become a hotspot and will continue to be a focus.

Conclusion

The study provides a comprehensive analysis of global research hotspots and trends in IC, and highlights the characteristics, challenges, and potential solutions of IC. To address resource fragmentation, collaboration difficulties, insufficient financial incentives, and poor information sharing, international collaboration needs to be strengthened to promote value co-creation and model innovation in IC. The contribution of this study lies in enhancing people's understanding of the current state of IC research, guiding scholars to discover new research perspectives, and providing valuable references for researchers and policymakers in designing and implementing effective IC strategies.

Effective health communication for age-related macular degeneration: An exploratory qualitative study

PURPOSE

Age-related macular degeneration (AMD) is a major cause of vision loss globally. Patients with AMD may not always understand or retain the information about AMD communicated by their eyecare practitioner. This study aims to explore the characteristics of effective health communication for AMD, from both patients' and eyecare practitioners' perspectives. The purpose is to provide a foundation for understanding how health communication for AMD could potentially be improved in the future.

METHODS

A total of 10 focus groups involving 17 patients with AMD and 17 optometrists were conducted via web conferencing. Each session was audio-recorded, transcribed and analysed using the Grounded Theory Methodology.

RESULTS

The five themes identified are as follows: (1) materials' quality, (2) materials' relevance, (3) contextualising for the individual, (4) contextualising for the disease and (5) support network. Participants expressed concern about the unrealistic yet common depiction of vision loss in AMD as a black patch overlying common visual scenes. They also preferred education materials tailored to a specific disease stage and the regular opportunity to ask or answer questions. Longer appointment durations and peer support (from family, friends or others with AMD) were also valued.

CONCLUSION

Optometrists are encouraged to focus on three over-arching dimensions when counselling patients with AMD in routine clinical practice: (1) curating and using disease and stage-specific, impactful education materials, (2) their chairside verbal communication techniques and (3) AMD-specific opportunities for care coordination among patient family and friends, peers and other multidisciplinary members of the care support team.

Factors Influencing the Purchase Intention for Online Health Popular Science Information Based on the Health Belief Model

There is a growing demand for health popular science information from the public. Online paid health popular science information provides a new channel for the public to obtain health popular science information and can meet users' demands for high-quality health popular science information. In order to improve the popularity of online paid health popular science information, it is urgent to investigate the factors influencing users' intention to pay for online health popular science information. Paid online health popular science information can provide users with higher-quality health knowledge, while monetary compensation can incentivize publishers to create and promote the sustainability of social media platforms. Therefore, paid online health popular science information is important for readers, creators, and platforms. Therefore, this study investigates the factors influencing users' intentions to purchase online health popular science information based on the health belief model (HBM). Our research data were obtained by a questionnaire and empirically analyzed by SmartPLS structural equation modeling. The results of this study indicate that the greater the perceived susceptibility, severity, and irreplaceability of health problems, the greater the intention of users to purchase health information when they read the summary portion of paid online health popular science information. And the higher the perceived risk and the more unreasonable the price of the online health popular science information, the lower the intention to purchase. Moreover, both the perceived susceptibility and perceived severity significantly attenuated the negative impacts of perceived health popular science information risk and perceived price unreasonableness on users' intentions to purchase online health popular science information. This study not only enriches and extends the application of the health belief model, but also has important positive implications for the development of online paid health popular science information.

Dose adjustment of rheumatology and allergy/immunology medications in chronic kidney disease: awareness and knowledge among internal medicine housestaff

Background

Patients with chronic kidney disease (CKD) are at increased risk for adverse drug events due to medication dosing errors. We studied the awareness and knowledge among internal medicine housestaff (IMHS) of proper dose adjustment of commonly used rheumatology and allergy/immunology medications for patients with CKD.

Methods

We surveyed 353 IMHS to evaluate their awareness of the need for medication dose adjustments for patients with CKD and knowledge for medication adjustment by level of glomerular filtration rate for common rheumatology and allergy/immunology medications.

Results

There was lack of awareness and knowledge for both rheumatology and allergy/immunology medications. Incorrect awareness and knowledge were as follows: allopurinol, 21.2%, 73.4%; colchicine, 19.0%, 75.9%; diphenhydramine, 34.0%, 34.0%; loratadine, 82.2%, 93.2%; and montelukast, 34.0%, 34.0%, respectively. Exploratory logistic regression analyses showed that PGY1 residents had higher odds for lack of awareness for allopurinol (odds ratio [OR] 24.57, 95% CI [confidence interval] 4.69, 99.13, P < 0.001), colchicine (OR 3.98, 95% CI 1.50, 10.51, P < 0.01), diphenhydramine (OR 2.24, 95% CI 1.10, 4.54, P < 0.04), and montelukast (OR 2.45, 95% CI 1.20, 5.00, P < 0.05) than PGY3 residents. A nephrology rotation in medical school was associated with lower odds for incorrect knowledge for allopurinol (OR 0.46, 95% CI 0.25, 0.87, P < 0.05) and montelukast (OR 0.50, 95% CI 0.27, 0.92, P < 0.05).

Conclusion

Overall, awareness and knowledge were poor among IMHS for dose adjustments of rheumatology and allergy/immunology medications in patients with CKD. Proper education and exposure to nephrology during training may improve quality and safety of care for patients with CKD.

Internet use among persons with common mental disorders: A qualitative study

Aims and Objectives

To assess the current patterns and experience of internet use among persons with depressive and anxiety disorders, particularly for health-related issues.

Methodology

In-depth interviews were conducted with persons diagnosed with depressive and anxiety disorders (DSM-5), aged ≥18 years who could read and write in Hindi/English, using an interview guide. The interview guide contained questions related to internet use in daily life, internet use for health-related issues, and internet use for stress, and internet use for anxiety/depressive disorder. Interview data were transcribed and analyzed to identify codes and subsequently themes.

Results

A total of 20 subjects; 10 each diagnosed with depressive and anxiety disorders were interviewed. About half the participants could operate internet independently, while rest required assistance. YouTube was the most common search engine used, and leisure was the most common reason for daily use. Almost all participants reported searching internet for health-related information including their psychiatric diagnosis. The most common purpose, for health in-general, was searching for alternate therapies. Most common purpose for psychiatric diagnosis was understanding the symptoms, recovery from their illness, and side effects of medicines. Highest impact as perceived by the participants was on distraction or stress reduction rather than direct impact on the illness/treatment.

Conclusion

Persons with depressive and anxiety disorders use internet for distraction, communication, and seeking information about the illness and medicines.

A case study of using natural language processing to extract consumer insights from tweets in American cities for public health crises

BACKGROUND

The COVID-19 pandemic was a "wake up" call for public health agencies. Often, these agencies are ill-prepared to communicate with target audiences clearly and effectively for community-level activations and safety operations. The obstacle is a lack of data-driven approaches to obtaining insights from local community stakeholders. Thus, this study suggests a focus on listening at local levels given the abundance of geo-marked data and presents a methodological solution to extracting consumer insights from unstructured text data for health communication.

METHODS

This study demonstrates how to combine human and Natural Language Processing (NLP) machine analyses to reliably extract meaningful consumer insights from tweets about COVID and the vaccine. This case study employed Latent Dirichlet Allocation (LDA) topic modeling, Bidirectional Encoder Representations from Transformers (BERT) emotion analysis, and human textual analysis and examined 180,128 tweets scraped by Twitter Application Programming Interface's (API) keyword function from January 2020 to June 2021. The samples came from four medium-sized American cities with larger populations of people of color.

RESULTS

The NLP method discovered four topic trends: "COVID Vaccines," "Politics," "Mitigation Measures," and "Community/Local Issues," and emotion changes over time. The human textual analysis profiled the discussions in the selected four markets to add some depth to our understanding of the uniqueness of the different challenges experienced.

CONCLUSIONS

This study ultimately demonstrates that our method used here could efficiently reduce a large amount of community feedback (e.g., tweets, social media data) by NLP and ensure contextualization and richness with human interpretation. Recommendations on communicating vaccination are offered based on the findings: (1) the strategic objective should be empowering the public; (2) the message should have local relevance; and, (3) communication needs to be timely.

Content analysis of social media regarding obesity as a chronic disease

Background

Social media is an effective online communication channel. Obesity has been classified as a chronic disease; yet, social media rarely portrays it as such. This study aims to explore the perception of obesity as a chronic disease through content analysis of social media content of obesity-related health organizations and weight loss commercial applications.

Methods

Using a codebook adapted from the definition of chronic disease, content analysis was conducted to evaluate a set of posts sampled from 11 health-related organizations and 10 weight loss applications Facebook and Twitter accounts. Descriptive statistics were used to assess the extent obesity was portrayed as a chronic disease.

Results

A total of 8,106 posts were extracted: 3,019 posts by organizations and 5,087 by weight loss commercial applications. Only 401 (4.5%) posts/tweets were related to obesity as a chronic disease and were posted by obesity-related health organizations. Only 69 (2.0%) posts from all the organizations' posts directly addressed the idea that obesity is a chronic disease. Almost none of the weight loss commercial apps' social media accounts tackled any aspect of obesity as a disease. Commercial applications' posts revolved mainly around recipes, exercise regimens, and behavioral advice, whereas organizations tackled more complications, treatment, and obesity bias.

Conclusion

Using content analysis of social media content, obesity-related health organizations and weight loss applications did not emphasize obesity as a chronic disease on their social media platforms of Facebook and Twitter. Weight-loss commercial applications on social media should include more posts to modify the public's perception regarding obesity as a disease, contributing to health promotion. Further research should explore other social media platforms and posts with specific hashtags posted by the general population.

Things I need you to know: a qualitative analysis of advice-giving statements in early-onset colorectal cancer patients' personal accounts published online

OBJECTIVE

People with early-onset colorectal cancer (EOCRC), defined as colorectal cancer (CRC) before the age of 50, now constitute a significant patient population. In empirical and grey literature EOCRC patients report unsatisfactory experiences of care, especially in relation to protracted intervals from first help-seeking to diagnosis. This study is the first to investigate EOCRC patients' perspectives on ways to improve experiences of care. The objective is to provide foundational knowledge for the development of EOCRC-specific patient-reported experience measures (PREMs).

DESIGN

The study was designed as qualitative Internet Mediated Research, involving a thematic analysis of unsolicited narratives recounting personal experiences of EOCRC care. We examined advice-giving statements in 120 online texts written by EOCRC patients and survivors.

SETTING

The Internet is the broad research setting. The host websites of three prominent charitable CRC support organisations were selected as specific research sites: Bowel Cancer Australia, Bowel Cancer UK and Bowel Cancer New Zealand.

RESULTS

We found that 90% of texts comprised statements of advice to new patients about the importance of self-advocacy in achieving quality care. Four key contexts for self-advocacy were identified: (1) accessing relevant diagnostic services; (2) driving diagnostic investigations when symptoms are not resolved; (3) involvement in treatment decision-making and (4) proactivity about preferred outcomes. Over 30% of advice-giving texts also directed statements of advice to healthcare providers, indicating that their youthfulness had been a barrier to timely diagnosis.

CONCLUSION

Healthcare barriers to, and facilitators of, patient self-advocacy may be indicators of quality EORC care. There is a need for greater awareness of the impact of age bias on the responsiveness of clinicians and healthcare services in EOCRC care. Our findings support the development of EOCRC-specific PREMs that can guide age-appropriate policy and practice for this newly identified patient population.

Chronic Diseases and Sociodemographic Characteristics Associated With Online Health Information Seeking and Using Social Networking Sites: Nationally Representative Cross-sectional Survey in Japan

BACKGROUND

In an aging society, worsening chronic diseases increase the burden on patients and the health care system. Using online health information including health information via social networking sites (SNSs), such as Facebook and YouTube, may play an important role in the self-management of chronic diseases and health promotion for internet users.

OBJECTIVE

This study aims to improve strategies for promoting access to reliable information for the self-management of chronic diseases via the internet, and to identify populations facing barriers to using the internet for health, we examined chronic diseases and characteristics associated with online health information seeking and the use of SNSs.

METHODS

This study used data from the INFORM Study 2020, which was a nationally representative cross-sectional postal mail survey conducted using a self-administered questionnaire in 2020. The dependent variables were online health information seeking and SNS use. Online health information seeking was assessed using 1 question about whether respondents used the internet to find health or medical information. SNS use was assessed by inquiring about the following 4 aspects: visiting SNSs, sharing health information on SNSs, writing in an online diary or blog, and watching a health-related video on YouTube. The independent variables were 8 chronic diseases. Other independent variables were sex, age, education status, work, marital status, household income, health literacy, and self-reported health status. We conducted a multivariable logistic regression model adjusted for all independent variables to examine the associations of chronic diseases and other variables with online health information seeking and SNS use.

RESULTS

The final sample for analysis comprised 2481 internet users. Hypertension or high blood pressure, chronic lung diseases, depression or anxiety disorder, and cancer were reported by 24.5%, 10.1%, 7.7%, and 7.2% of respondents, respectively. The odds ratio of online health information seeking among respondents with cancer was 2.19 (95% CI 1.47-3.27) compared with that among those without cancer, and the odds ratio among those with depression or anxiety disorder was 2.27 (95% CI 1.46-3.53) compared with that among those without. Further, the odds ratio for watching a health-related YouTube video among those with chronic lung diseases was 1.42 (95% CI 1.05-1.93) compared with that among those without these diseases. Women, younger age, higher level of education, and high health literacy were positively associated with online health information seeking and SNS use.

CONCLUSIONS

For patients with cancer, strategies for promoting access to websites with reliable cancer-related information as well as access among patients with chronic lung diseases to YouTube videos providing reliable information may be beneficial for the management of these diseases. Moreover, it is important to improve the online environment to encourage men, older adults, internet users with lower education levels, and those with low health literacy to access online health information.

The Usage and Trustworthiness of Various Health Information Sources in the United Arab Emirates: An Online National Cross-Sectional Survey

Background: The increase in the quality and availability of health information as well as the accessibility of Internet-based sources, has driven growing demand for online health information. Information preferences are influenced by many factors, including information needs, intentions, trustworthiness, and socioeconomic variables. Hence, understanding the interplay of these factors helps stakeholders provide current and relevant health information sources to assist consumers in assessing their healthcare options and making informed medical decisions. Aims: To assess the different sources of health information sought by the UAE population and to investigate the level of trustworthiness of each source. Methods: The study adopted a descriptive online cross-sectional design. A self-administered questionnaire was used to collect data from UAE residents aged 18 years or above between July 2021 and September 2021. Health information sources, their trustworthiness, and health-oriented beliefs were explored through univariate, bivariate, and multivariate analysis in Python. Results: A total of 1083 responses were collected, out of which 683 (63%) were females. Doctors were the first source of health information (67.41%) before COVID-19, whereas websites were the first source (67.22%) during the pandemic. Other sources, such as pharmacists, social media, and friends and family, were not prioritized as primary sources. Overall, doctors had a high trustworthiness of 82.73%, followed by pharmacists with a high trustworthiness of 59.8%. The Internet had a partial trustworthiness of 58.4%. Social media and friends and family had a low trustworthiness of 32.78% and 23.73%, respectively. Age, marital status, occupation, and degree obtained were all significant predictors of Internet usage for health information. Conclusions: The population in the UAE commonly obtains health information from doctors who have been shown to have the highest trustworthiness; this is despite it not being the most common source used.

Readability of Online Patient Education Materials for Graft-Versus-Host Disease

Graft-versus-host disease (GVHD) is a complex systemic diagnosis which is associated with significant symptom distress in patients. Patient education has shown to mitigate uncertainty and distress, but to our knowledge, no studies have evaluated patient education materials on GVHD. We characterized the readability and understandability of patient education materials on GVHD available online. We conducted a Google search of the top 100 non-sponsored search results, selecting for full-text patient education that is not peer-reviewed or a news article. We evaluated the text of the eligible search results against the Flesch-Kincaid Reading Ease, Flesch Kincaid Grade Level, Gunning Fog, Automated Readability, Linsear Write Formula, Coleman-Liau Index, Smog Index, and Patient Education Materials Assessment Tool (PEMAT) for understandability. Among 52 included Web results, 17 (32.7%) were provider-authored and 15 (28.8%) were hosted on university Web sites. The total average scores on validated readability tools were Flesch-Kincaid Reading Ease (46.4), Flesch Kincaid Grade Level (11.6), Gunning Fog (13.6), Automated Readability (12.3), Linsear Write Formula (12.6), Coleman-Liau Index (12.3), Smog Index (10.0), and PEMAT Understandability (65.5). Provider-authored links scored poorer than non-provider-authored links on all metrics, with significant differences for the Gunning Fog index (p < 0.05). University-hosted links scored better than non-university-hosted links on all metrics. Evaluation of online patient education materials for GVHD demonstrates the need for more readable and understandable resources to mitigate the distress and uncertainty that patients may feel upon being diagnosed with GVHD.

Internet Use for Obtaining Medicine Information: Cross-sectional Survey

BACKGROUND

The internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies. Poor interpretation of medicine information can lead to anxiety and poor adherence to drug therapy. It is therefore important to understand how people search, select, and trust medicine information.

OBJECTIVE

The objectives of this study were to establish the extent of internet use for seeking medicine information among Norwegian pharmacy customers, analyze factors associated with internet use, and investigate the level of trust in different sources and websites.

METHODS

This is a cross-sectional study with a convenience sample of pharmacy customers recruited from all but one community pharmacy in Tromsø, a medium size municipality in Norway (77,000 inhabitants). Persons (aged ≥16 years) able to complete a questionnaire in Norwegian were asked to participate in the study. The recruitment took place in September and October 2020. Due to COVID-19 restrictions, social media was also used to recruit medicine users.

RESULTS

A total of 303 respondents reported which sources they used to obtain information about their medicines (both prescription and over the counter) and to what extent they trusted these sources. A total of 125 (41.3%) respondents used the internet for medicine information, and the only factor associated with internet use was age. The odds of using the internet declined by 5% per year of age (odds ratio 0.95, 95% CI 0.94-0.97; P=.048). We found no association between internet use and gender, level of education, or regular medicine use. The main purpose reported for using the internet was to obtain information about side effects. Other main sources of medicine information were physicians (n=191, 63%), pharmacy personnel (n=142, 47%), and medication package leaflets (n=124, 42%), while 36 (12%) respondents did not obtain medicine information from any sources. Note that 272 (91%) respondents trusted health professionals as a source of medicine information, whereas 58 (46%) respondents who used the internet trusted the information they found on the internet. The most reliable websites were the national health portals and other official health information sites.

CONCLUSIONS

Norwegian pharmacy customers use the internet as a source of medicine information, but most still obtain medicine information from health professionals and packet leaflets. People are aware of the potential for misinformation on websites, and they mainly trust high-quality sites run by health authorities.

Online news coverage of infant formula shortage in the United States: A content analysis

This study aimed to describe the content of internet news specific to the 2022 infant formula shortage in the United States. First hundred English news articles on Google News were coded for content categories to reflect recommendations for affected families by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Chi-square test of independence (α = 0.05) determined if content categories was statistically affected by whether the news article was professionally authored or an internet news article. Only 17% of the articles were professionally authored. Hardships to parents was the predominant theme (73% of news articles); 53% mentioned challenges for infants needing hypoallergenic or specialized formulas; 52% addressed food safety. Coverage of feeding guidelines, challenges for specialized formula requirements, introduction to solid foods, re-lactation, breastfeeding support, and food safety were not significantly impacted by whether the article was professionally authored or not (p > .05). Results point to the need for health professionals to increase their online presence as a vital source of accurate information during a public health crisis.

Didactical characteristics of Dutch websites about kidney transplantation targeted for kidney patients and living donors: An exploratory study

Objective

The aim was to explore the origin, content topics, teaching modes (instruction, interaction, and assessment), and corresponding social-epistemological dimensions (choices in knowledge transfer vs. knowledge building, and individual vs. group learning) of web-based information on kidney transplantation targeted for patients and living donors.

Methods

Dutch websites on kidney transplantation were retrieved using the search engine Google.nl. From 24 websites, 250 webpages were examined on origin, content topics, teaching modes, and corresponding social-epistemological dimensions.

Results

The majority of the websites had a professional organization as origin (20/24). The number and distribution of content topics varied among the websites. Of the 16 different teaching modes found, 11 were instructional, 4 were interactional, and 1 assessment mode was found. The websites offered almost exclusively teaching modes on individual and passive learning, whereas group learning and interactive knowledge building was hardly encountered.

Conclusion

The diversity in teaching modes and social-epistemological dimensions of Dutch websites on kidney transplantation targeted for patients and living donors is limited. The websites only provided a partial view on kidney transplantation; information regarding contact with others, e.g. support, was limited. A more balanced availability of teaching approaches and content topics is desirable to fit with the didactical goals to make well-considered health decisions.

Web-Based Health Information–Seeking Methods and Time Since Provider Engagement: Cross-sectional Study

Background

The use of web-based methods to seek health information is increasing in popularity. As web-based health information (WHI)–seeking affects health-related decision support and chronic symptom self-management, WHI-seeking from online sources may impact health care decisions and outcomes, including care-seeking decisions. Patients who are routinely connected to physicians are more likely to receive better and more consistent care. Little is known about whether WHI-seeking impacts the frequency at which patients engage with health care providers.

Objective

Our primary objective was to describe the associations between the use of web-based methods to seek information about one’s own health and the time since last engaging with a health care provider about one’s own health. Additionally, we aimed to assess participants’ trust in health care organizations to contextualize our findings.

Methods

We analyzed data from US adults participating in the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Survey (N=1034). Bivariate associations between demographic characteristics and health information–seeking methods were assessed with Pearson chi-squared tests. Bivariate associations of Medical Mistrust Index (MMI) scores with each health information–seeking method and time since provider engagement were assessed with F tests and adjusted Wald tests. We fit a multivariable logistic regression model to assess the association between WHI-seeking within the 12 months prior to survey (alone or in combination with provider-based methods versus provider only) and engagement with a provider more than 1 year prior to the time of survey, adjusting for age, race and ethnicity, sex, education, insurance coverage, and MMI.

Results

Age, race and ethnicity, educational attainment, health insurance source, MMI, and time since provider engagement were each significantly associated with the health information–seeking method in bivariate analyses. Compared to using only provider-based health information seeking methods, WHI-based methods alone or in combination with provider-based methods were associated with a 51% lower likelihood (odds ratio 0.49, 95% CI 0.27-0.87) of engaging with a provider within the previous year. Participants who used WHI-seeking methods alone and those who had not engaged with a health care provider within the previous year demonstrated a higher mean MMI score; however, MMI was not a significant predictor of time since engagement with a provider in the multivariable analysis.

Conclusions

Our findings from a nationally representative survey suggest that for those who use WHI-seeking methods (alone or in combination with provider-based information-seeking methods), there is a statistically significant lower likelihood of engaging with a provider in a year compared to those who only use provider-based methods. Future research should consider the intent of a person’s visit with a provider, trust in health care systems, methods of provider engagement, and specific web-based platforms for health information.

Evaluating a theory-based intervention for improving eHealth literacy in older adults: a single group, pretest-posttest design

BACKGROUND

The Internet is considered an important channel for providing health information to older adults. We developed an intervention to improve eHealth literacy in older adults according to the information-motivation-behavioral skills (IMB) theory and Intervention Mapping. This study aimed to analyze the effect of a developed intervention on information, motivation, behavioral skills, and behaviors related to eHealth information in older adults.

METHODS

Forty-six older adults over the age of 65 were recruited from two senior welfare centers in a city in South Korea. We divided the participants into four groups and conducted one intervention per group from March to December 2019. One intervention consisted of 5 sessions and was performed once a week (2 h/1 time) for 5 weeks, culminating in a total lecture time of 10 h. One lecture instructor and two assistant instructors supported the participants in the computer practices.

RESULTS

Participants' computer/web knowledge, perceived ease of use, perceived enjoyment, and attitude toward eHealth information showed statistically significant increases. The eHealth literacy efficacy score, searching performance score, and understanding score were also significantly increased. However, there was no significant difference in perceived usefulness.

CONCLUSION

The application of the current theory-based methodology can improve the quality of research in eHealth literacy. Additionally, various interventions should be developed and continuously applied to improve eHealth literacy among older adults.

An evaluation of the readability and visual appearance of online patient resources for fibroadenoma

INTRODUCTION

Fibroadenomas are benign lesions found in the breast tissue. Widespread access to and use of the internet has resulted in more individuals using online resources to better understand health conditions, their prognosis and treatment. The aim of this study was to investigate the readability and visual appearance of online patient resources for fibroadenoma.

METHODS

We searched GoogleTM, BingTM and YahooTM on 6 July 2022 using the search terms "fibroadenoma", "breast lumps", "non-cancerous breast lumps", "benign breast lumps" and "benign breast lesions" to identify the top ten websites that appeared on each of the search engines. We excluded advertised websites, links to individual pdf documents and links to blogs/chats. We compiled a complete list of websites identified using the three search engines and the search terms and analysed the content. We only selected pages that were relevant to fibroadenoma. We excluded pages which only contained contact details and no narrative information relating to the condition. We did not assess information where links were directed to alternative websites. We undertook a qualitative visual assessment of each of the websites using a framework of pre-determined key criteria based on the Centers for Medicare and Medicaid Services toolkit. This involved assessing characteristics such as overall design, page layout, font size and colour. Each criterion was scored as: +1- criterion achieved; -1- criterion not achieved; and 0- no evidence, unclear or not applicable (maximum total score 43). We then assessed the readability of each website to determine the UK and US reading age using five different readability tests: Flesch Kincaid, Gunning Fog, Coleman Liau, SMOG, and the Automated Readability Index. We compared the readability scores to determine if there were any significant differences across the websites identified. We also generated scores for the Flesh Reading Ease as well as information about sentence structure (number of syllables per sentence and proportion of words with a high number of syllables) and proportion of people the text was readable to.

RESULTS

We identified 39 websites for readability and visual assessment. The visual assessment scores for the 39 websites identified ranged from -19 to 31 points out of a possible score of 43. The median readability score for the identified websites was 8.58 (age 14-15), with a range of 6.69-12.22 (age 12-13 to university level). There was a statistically significant difference between the readability scores obtained across websites (p<0.001). Almost half of the websites (18/39; 46.2%) were classified as very difficult by the Flesch Reading Ease score, with only 13/39 (33.33%) classified as being fairly easy or plain English.

CONCLUSION

We found wide differences in the general appearance, layout and focus of the fibroadenoma websites identified. The readability of most of the websites was also much higher than the recommended level for the public to understand. Fibroadenoma website information needs to be simplified to reduce the use of jargon and specificity to the condition for individuals to better comprehend it. In addition, their visual appearance could be improved by changing the layout and including images and diagrams.

What information about choosing a nursing home is available on YouTube?

This study aimed to identify YouTube videos focused on choosing a nursing home. The contents of the videos were analyzed using 19 items from the guidelines proposed by the Donabedian model. An analysis of 57 videos showed that informal presentations for format (54.39%), laypersons for speaker (36.84%), and personal channel for uploader (61.40%) exhibited the highest frequency. According to the analysis of video content, most videos included the environment (49.12%), programs (38.63%), and cost (35.09%). However, fewer videos focused on care protocols (5.26%), participation (5.26%) and health outcomes (5.26%). More informal presentations, laypersons, and personal channels than health providers, professional groups, and mass media were included in videos focused on choosing nursing homes. It is necessary to provide information regarding the philosophy, care, and health outcomes of residents in addition to the information regarding environment and cost provided by reliable suppliers, such as health professionals, the government, and mass media.

Assessing the quality of publicly available videos on MDMA-assisted psychotherapy for PTSD

BACKGROUND AND OBJECTIVES

Patients increasingly rely on the Internet for healthcare information. This study aimed to evaluate the quality of videos on 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for posttraumatic stress disorder (PTSD) on YouTube™.

METHODS

YouTube™ was searched for the terms "MDMA" and "PTSD." The 100 most viewed videos were analyzed using three standard quality measures: Global Quality Scores (GQS), JAMA benchmark, and DISCERN. Viewer engagement features and source of upload, video duration, inclusion of patient narrative and/or MD/DO/PhD, the mention of lack of Food and Drug Administration (FDA) approval, side effects, potential for abuse, and use in conjunction with psychotherapy were recorded.

RESULTS

The videos were of poor quality (mean GQS: 2.26 ± 0.94/5, JAMA: 1.96 ± 0.45/4, and DISCERN: 29.5 ± 8.2/80). A significant positive association was found between video quality and duration (GQS: r = .5857, p < .0001, JAMA: r = .279, p = .0409, DISCERN: r = .5783, p < .0001). Videos including an MD/DO/PhD had the highest scores (GQS: 2.87/5 [1.22], p = .006, DISCERN: 38.35/80 [13.32], p < .0003). A minority of videos were uploaded by academic institutions (1%); most were from professional organizations (29%). No correlation was found between quality and viewer engagement features-number of views, subscribers, likes/dislikes, or comments. A majority mentioned that MDMA must be used in conjunction with psychotherapy (85%) and is not FDA-approved (82%) for PTSD. Only 32% of videos mentioned risks or potential for abuse.

CONCLUSIONS

These findings highlight the need for better quality of online health material and an opportunity for involvement of healthcare professionals in the dissemination of accurate health information via content creation.

SCIENTIFIC SIGNIFICANCE

This is the first study to examine publicly available information on the use of MDMA for PTSD.

Laypeople's Online Health Information Search Strategies and Use for Health-Related Problems: Cross-sectional Survey

Background

With the increase in the use of the internet to search for health information about health-related problems, there is a need for health care professionals to better understand how their patients search for and use the online health information that may influence their medical decision making.

Objective

The aims of this study are to explore laypeople’s online health information search strategies and examine the relationships between their search strategies and utilization behavior of online health information.

Methods

Two scales, namely match and elaboration, were used to measure patients’ basic search strategies (ie, simple approach) and advanced search strategies (ie, integrative approach), respectively. In addition, the consultation scale was used to evaluate the participants’ use of online health information to consult doctors and others. A total of 253 outpatients without university education were purposely selected and surveyed. The participants were outpatients at a university-affiliated teaching hospital. Partial least squares-structural equation modeling (PLS-SEM) was performed to analyze the measurement model to specify the measurement validation. In addition, the structure model of PLS-SEM was evaluated to examine the path correlations between variables and to execute interaction effect and curvilinear relationship analyses.

Results

The results of the path correlation analysis by PLS-SEM showed that both elaboration strategy (path coefficient=0.55, P<.001) and match strategy (path coefficient=0.36, P<.001) were positively correlated with consultation on online health information with doctors and others. In addition, interaction effect and curvilinear relationship analyses indicated that there was a significant interaction effect between elaboration and match on consultation (path coefficient=–0.34, P<.001) and a significant curvilinear relationship between match and consultation (path coefficient=–0.09, P=.046).

Conclusions

Increasing patients’ exposure to online health information through both a simple search approach (ie, match strategy) and a complex search approach (ie, elaboration strategy) may lead them to appropriately use the information to consult doctors and others. However, the results of interaction effect and curvilinear relationship analyses highlighted the essential role of the elaboration strategy to properly locate, evaluate, and apply online health information. The findings of this study may help health care professionals better understand how to communicate with their patients through the health information on the internet.

Public knowledge and information sources for clinical trials among adults in the USA: evidence from a Health Information National Trends Survey in 2020

BACKGROUND

Lack of clinical trial awareness has been identified as a barrier to clinical trial recruitment. Identifying factors associated with clinical trial knowledge could inform ongoing efforts to improve diversity in clinical trials.

METHODS

Using data from the Health Information National Trends Survey, 2020, we examined the knowledge of clinical trials, associated characteristics, sources of clinical trial information and motives to participate in clinical trials among the general population in the USA.

RESULTS

Of 3,772 US adults, 41.3% reported not knowing about clinical trials. Prevalence of having no knowledge of clinical trials was higher among Hispanic adults (51.8%) and non-Hispanic Black adults (41.8%) compared with non-Hispanic White adults (37.4%; p=0.013). Other significant predictors of knowledge about clinical trials included higher education, online health information-seeking behaviour and patient portal access. Most respondents (73.2%) reported that healthcare providers were the most trusted source of information. Helping other people (71.6%) was the primary motivation for clinical trial participation, followed by financial compensation (12.5%) and receiving better treatment (5.1%).

CONCLUSION

There is a gap in knowledge about clinical trials among the US population. Development of multimodal approaches, including online and offline information broadcasting, is needed to improve knowledge and clinical trial recruitment in diverse populations.