How Technology, Health Information Seeking, and Socioeconomic Factors Are Associated With Coronavirus Disease 2019 Vaccination Readiness in Estonians Over 50 Years?

Despite the proven effectiveness of COVID-19 vaccines in preventing severe illness, many individuals, including older adults who are most susceptible to the virus, have opted against vaccination. Various factors could shape vaccination decisions, including seeking health information (HI). The internet is the primary source of HI today; however, older adults are often referred to as those missing out on digital benefits. The study explores the correlations between information and communication technology (ICT) use, online HI seeking, socioeconomic factors, and COVID-19 vaccination readiness among individuals aged 50 and above in Estonia. The survey data were gathered from 501 people aged 50 and older after the first lockdown in 2020. The outcomes revealed that vaccination readiness positively correlated with factors such as higher educational attainment, greater income, male gender, access to ICT, a readiness to employ digital technologies for health-related purposes, a greater demand for HI, and a higher frequency of seeking it online. There was some discrepancy in the preference of HI sources; for example, vaccination consenters preferred online versions of professional press publications and specific health portals. Based on the findings, it is advisable to encourage older adults to utilize the internet and new technology for health-related purposes. This practice expands the range of information sources available to them, ultimately enabling better decision-making regarding their health behaviors.

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.

Online health information-seeking behaviours for low back pain in the United Kingdom: analysis of data from Google trends and the Global Burden of Disease Study, 2004-2019

BACKGROUND

Low back pain (LBP) is a leading cause of global disability. Timely health-seeking is crucial for early diagnosis and management of pathologies. Despite increases in internet usage, there is sparse literature regarding online health information-seeking behaviours (OHISBs) for LBP and how they correlate with the LBP disease burden in the UK.

METHODS

To examine OHISB trends, we conducted Prais-Winsten analyses on monthly search volume data from Google Trends in the UK between 1 January 2004 and 1 December 2019. Cross-correlation analyses assessed the relationship between annual LBP search volume and LBP morbidity and mortality data from the Global Burden of Disease study (2004-2019).

RESULTS

From 2004 to 2019, the trend in LBP search volume was curvilinear (β=1.27, t=5.00, p<0.001), with a slope change around the end of 2006. There was a negative linear trend (β=-0.25, t35=-1.52, p<0.14) from 2004 to 2006 and a positive linear trend (β=0.67, t108=9.17, p<0.001) from 2007 to 2019. Cross-correlations revealed positive associations between search volume and disease burden indicators for LBP such as prevalence and incidence at lags 4 and 5.

CONCLUSIONS

A rising trend in OHISBs for LBP was noted between 2004 and 2019. This trend positively correlates with incidence, prevalence and burden measures. These findings emphasise the importance of high-quality online resources to increase awareness around LBP, facilitating early diagnosis and management.

Assessment of Arabic Web-Based Knowledge About Clear Aligners: An Infodemiologic Study

BACKGROUND

Orthodontic treatments aim to enhance dental aesthetics, functionality, and long-term oral health. Clear aligners have gained popularity as an aesthetic and convenient option for patients seeking orthodontic correction. However, the quality and readability of online Arabic patient-centered information regarding clear aligners has not been studied yet. The aim of our study is to investigate the quality and readability of Arabic patient-centered information about clear aligners.

METHODS

We conducted an extensive evaluation of Arabic web-based content pertaining to clear aligners using three prominent search engines. Eligible websites were categorized based on specialization, organizational affiliation, material type, and presentation style. We assessed website quality and reliability using the DISCERN instrument, Journal of American Medical Association (JAMA) benchmarks, and Health on the Net (HON) code. In addition, we measured readability using the Flesch Reading Ease Score (FRES), Simplified Measure of Gobbledygook (SMOG), and Flesch-Kincaid Grade Level (FKGL).

RESULTS

Out of 600 search results, 195 websites met the inclusion criteria. None of the websites were HON-code accredited. DISCERN assessments revealed low content quality, with none of the websites achieving high-quality status. The JAMA benchmarks showed limited compliance with the four items, with currency being the most frequently achieved. Readability assessments indicated generally high readability, with FKGL scores suggesting easy comprehension for the average readers.

CONCLUSION

While Arabic web-based information on clear aligners is highly readable, its credibility and quality require significant improvement. Websites should adhere to medical information standards, subject content to rigorous assessments, and seek accreditation to ensure reliability. Enhancing the accessibility and comprehensibility of health-related content will empower individuals to make informed health decisions. Addressing limitations, such as social media and video content evaluation, and conducting comparisons with English websites in future research will provide a more comprehensive understanding of the landscape of online orthodontic information.

Adolescent pursuit of health information online during the COVID-19 pandemic: The roles played by eHealth literacy and psychological distress

COVID-19 has led to an increase in mental health problems for adolescents. In this study, we examined the factors related to the eHealth literacy of adolescents and how that impacted their pursuit of health information and mental health information online during the COVID-19 pandemic. We analyzed data from the 2020 Taiwan Communication Survey, which involved a total of 1,250 national representative adolescents who completed an online questionnaire. The results showed that two-thirds of adolescents reported searching for health information online, and about half of them reported searching for mental health information online during the COVID-19 pandemic. Multivariate analysis results indicated that adolescents who spent more time learning online, had higher levels of bonding social capital and self-determination, and had higher levels of parental active internet mediation were more likely to have higher levels of eHealth literacy. In addition, multivariate analysis results showed that adolescents who had higher levels of eHealth literacy and had higher depression and anxiety were more likely to seek health information and mental health information online. In conclusion, the levels of eHealth literacy and psychological distress of adolescents played a crucial role in their pursuit of health information and mental health information online during the COVID-19 pandemic.

Online health information seeking and the association with anxiety among older adults

Introduction

The Internet supplies users with endless access to a wealth of information and is generally the first source searched by U.S. adults (18 years and older) when seeking health information. Age and anxiety are associated with online health information seeking (OHIS). Older adults (65 years and older) are increasing their OHIS. Importantly, OHIS can potentially lead to improved health outcomes for older adults. The relationship between OHIS and anxiety is less clear. Studies report those with more symptoms of anxiety are more likely to be OHIS, while other studies find the reverse pattern or no association. Generalized anxiety disorder affects up to 11% of older adults and is oftentimes unrecognized and untreated.

Methods

To address the mixed findings in the literature, we analyzed six waves (2015-2020) of data from the National Health and Aging Trends Study to assess the causal relationship between anxiety and OHIS using a Random Intercept Cross-lagged Panel Model framework.

Results

We found that while anxiety symptoms lead to OHIS in the next wave, OHIS was not associated with anxiety symptoms in the next wave.

Discussion

This suggests that for this sample of older adults, OHIS does not reduce or exacerbate older adults' symptoms of anxiety.

Online Health Information Seeking by Individuals With Physical Disabilities Caused by Neurological Conditions in Saudi Arabia

Background In recent years, there has been an increase in the use of the internet and information technology for accessing health information. This study aimed to determine the factors that affect patients with neurological disabilities and their willingness to search for information via the internet. In addition, we aimed to assess how patients manage this information, considering the increasing availability of online information and websites that discuss health and diseases, as well as the spread of communication technology and its accessibility to the public. Methodology A cross-sectional, online, self-administered, questionnaire study was conducted in Saudi Arabia. The study targeted patients with neurological diseases who had disabilities. The questionnaire was designed to measure the demographic data, physical disability using the 10-item physical function component of the 36-Item Short Form Health survey, the perceived usefulness of online health information, the perceived ease of use, and the perceived risk of online health information. Lastly, the questionnaire measured online health information-seeking intentions and information use. Data analysis was performed using RStudio (R version 4.1.1, Posit, Boston, USA). Results We received 1,179 responses, of which 399 were excluded due to using another way to get information rather than the internet, 31 did not have neurological disabilities, and 136 did not complete the questionnaire. The remaining 613 responses were included in the final analysis. The participants were mostly male (54.6%), not married (54.6%), and had a bachelor's degree (49.99%). The average age of participants was 18-25 years (24.5%) and 26-35 years (23.2%), Additionally, most participants resided in the western (26.9%) and eastern (25.9%) regions. Most participants (39.5%) had a monthly income of 5,000 to 10,000 SAR. Further, the most common neurological diseases were multiple sclerosis and epilepsy (26.9% and 23.2%, respectively). Based on the analysis of the data, the most important factor affecting online health information-seeking intention was that people with higher monthly incomes were more likely to seek online health information; these included people with an income of 10,000-20,000 SAR and >20,000 SAR. The most common factor affecting information use was the region of residence. The southern and western regions were less likely to adopt information use. Conclusions The monthly income and the area of residence had the greatest impact on people with neurological disabilities who sought online health information in the Kingdom of Saudi Arabia. Educational campaigns and workshops should be arranged to increase the population's awareness of this topic, as well as to reveal the extent and prevalence of online health information seeking among disabled patients.

Understanding online health information seeking behavior of older adults: A social cognitive perspective

Introduction

Online health information seeking has been verified to play a crucial role in improving public health and has received close scholarly attention. However, the seeking behavior of older adults, especially the underlying mechanism through which they are motivated to seek health information online, remains unclear. This study addresses the issue by proposing a theoretical model leveraging social cognitive theory.

Methods

IT self-efficacy and IT innovativeness were identified as personal factors and professional support and social support were identified as environmental factors. We conducted a survey that included 347 older people in China and examined the research hypotheses with a structural equation model.

Results

IT self-efficacy and IT innovativeness facilitate older adults to seek health information online by increasing their perceived benefit of using the internet. Additionally, professional support and social support enhanced older adults' online seeking behavior by promoting their health awareness. We also found that perceived benefit displayed a stronger impact than health awareness on older adults' behavior related to searching for health information online.

Conclusion

This study reveals that IT self-efficacy, IT innovativeness, professional support, and social support will promote older adults to seek health information online by enhancing their health awareness and perceived benefit. The findings of this study provide significant theoretical and practical implications.

Insights into the antecedents of cyberchondria: a perspective from the USA

This study establishes a theoretical framework for assessing antecedents of cyberchondria, which is a process of amplified anxiety about one's health because of excessive online health information seeking. We examined the framework through partial least squares structural equation modeling after collecting data through a cross-sectional online survey. This research contributes to the literature by (i) evaluating the roles of health anxiety (HA) and affective responses (AR) on cyberchondria; (ii) equipping health strategists with understanding about ways to tailor their educational and communication strategies to specific segments by importance-performance map analysis and necessary condition analysis. Finally, by (iii) providing strategic tactics to curb cyberchondria so that it becomes possible to attain a better patient outcome. Findings suggest that the existing association between intolerance of uncertainty and cyberchondria is serially mediated by HA and AR. For healthcare educators and practitioners, the findings of this research deliver a blueprint for effectively controlling cyberchondria.

Online Health Information Seeking for Self and Child: An Experimental Study of Parental Symptom Search

BACKGROUND

Parents often search the web for health-related information for themselves or on behalf of their children, which may impact their health-related decision-making and behaviors. In particular, searching for somatic symptoms such as headaches, fever, or fatigue is common. However, little is known about how psychological and relational factors relate to the characteristics of successful symptom-related internet searches. To date, few studies have used experimental designs that connect participant subjective search evaluation with objective search behavior metrics.

OBJECTIVE

This study aimed to examine the features of web-based health-related search behaviors based on video-coded observational data, to investigate which psychological and relational factors are related to successful symptom search appraisal, and to examine the differences in search-related outcomes among self-seekers and by-proxy seekers.

METHODS

In a laboratory setting, parents living in Austria (N=46) with a child aged between 0 and 6 years were randomized to search their own (n=23, 50%) or their child's (n=23, 50%) most recent somatic symptom on the web. Web-based activity was recorded and transcribed. Health anxiety, eHealth literacy, attitude toward web-based health information, relational variables, state of stress, participants' search appraisals, and quantitative properties of the search session were assessed. Differences in search appraisals and search characteristics among parents who searched for themselves or their children were examined.

RESULTS

Across both groups, searches were carried out for 17 different symptom clusters. Almost all parents started with Google (44/46, 96%), and a majority used initial elaborated key phrases with >1 search keyword (38/45, 84%) and performed on average 2.95 (SD 1.83) search queries per session. Search success was negatively associated with health anxiety (r_s=-0.39, P=.01), stress after the search (r_s=-0.33, P=.02), and the number of search queries (r_s=-0.29, P=.04) but was not significantly associated with eHealth literacy (r_s=0.22, P=.13). Of note, eHealth literacy was strongly and positively correlated with satisfaction during the search (r_s=0.50, P<.001) but did not significantly correlate with search characteristics as measured by search duration (r_s=0.08, P=.56), number of performed search queries (r_s=0.20, P=.17), or total clicks (r_s=0.14, P=.32). No differences were found between parents searching for their own symptoms and parents searching for their child's symptoms.

CONCLUSIONS

This study provides exploratory findings regarding relevant dimensions of appraisals for symptom-based information seeking on the web. Consistent with previous literature, health anxiety was found to be associated with poorer search evaluation. Contrary to expectations, eHealth literacy was related neither to search success nor to search characteristics. Interestingly, we did not find significant differences between self-seekers and by-proxy seekers, suggesting similar search and evaluation patterns in our sample. Further research with larger samples is needed to identify and evaluate guidelines for enhanced web-based health information seeking among parents and the general public.

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

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

Modeling Access Across the Digital Divide for Intersectional Groups Seeking Web-Based Health Information: National Survey

Background

The digital divide refers to technological disparities based on demographic characteristics (eg, race and ethnicity). Lack of physical access to the internet inhibits online health information seeking (OHIS) and exacerbates health disparities. Research on the digital divide examines where and how people access the internet, whereas research on OHIS investigates how intersectional identities influence OHIS. We combine these perspectives to explicate how unique context–device access pairings operate differently across intersectional identities—particularly racial and ethnic groups—in the domain of OHIS.

Objective

This study aims to examine how different types of internet access relate to OHIS for different racial and ethnic groups. We investigate relationships among predisposing characteristics (ie, age, sex, education, and income), internet access (home computer, public computer, work computer, and mobile), health needs, and OHIS.

Methods

Analysis was conducted using data from the 2019 Health Information National Trends Survey. Our theoretical model of OHIS explicates the roles of internet access and health needs for racial and ethnic minority groups’ OHIS. Participant responses were analyzed using structural equation modeling. Three separate group structural equation modeling models were specified based on Black, Latine, and White self-categorizations.

Results

Overall, predisposing characteristics (ie, age, sex, education, and income) were associated with internet access, health needs, and OHIS; internet access was associated with OHIS; and health needs were associated with OHIS. Home computer and mobile access were most consistently associated with OHIS. Several notable linkages between predisposing characteristics and internet access differed for Black and Latine individuals. Older racial and ethnic minorities tended to access the internet on home and public computers less frequently; home computer access was a stronger predictor of OHIS for White individuals, and mobile access was a stronger predictor of OHIS for non-White individuals.

Conclusions

Our findings necessitate a deeper unpacking of how physical internet access, the foundational and multifaceted level of the digital divide, affects specific racial and ethnic groups and their OHIS. We not only find support for prior work on the digital divide but also surface new insights, including distinct impacts of context–device access pairings for OHIS and several relationships that differ between racial and ethnic groups. As such, we propose interventions with an intersectional approach to access to ameliorate the impact of the digital divide.

Online Health Information Seeking Behaviors Among Older Adults: Systematic Scoping Review

Background

With the world’s population aging, more health-conscious older adults are seeking health information to make better-informed health decisions. The rapid growth of the internet has empowered older adults to access web-based health information sources. However, research explicitly exploring older adults’ online health information seeking (OHIS) behavior is still underway.

Objective

This systematic scoping review aims to understand older adults’ OHIS and answer four research questions: (1) What types of health information do older adults seek and where do they seek health information on the internet? (2) What are the factors that influence older adults’ OHIS? (3) What are the barriers to older adults’ OHIS? (4) How can we intervene and support older adults’ OHIS?

Methods

A comprehensive literature search was performed in November 2020, involving the following academic databases: Web of Science; Cochrane Library database; PubMed; MEDLINE; CINAHL Plus; APA PsycINFO; Library and Information Science Source; Library, Information Science and Technology Abstracts; Psychology and Behavioral Sciences Collection; Communication & Mass Media Complete; ABI/INFORM; and ACM Digital Library. The initial search identified 8047 publications through database search strategies. After the removal of duplicates, a data set consisting of 5949 publications was obtained for screening. Among these, 75 articles met the inclusion criteria. Qualitative content analysis was performed to identify themes related to the research questions.

Results

The results suggest that older adults seek 10 types of health information from 6 types of internet-based information sources and that 2 main categories of influencing factors, individual-related and source-related, impact older adults’ OHIS. Moreover, the results reveal that in their OHIS, older adults confront 3 types of barriers, namely individual, social, and those related to information and communication technologies. Some intervention programs based on educational training workshops have been created to intervene and support older adults’ OHIS.

Conclusions

Although OHIS has become increasingly common among older adults, the review reveals that older adults’ OHIS behavior is not adequately investigated. The findings suggest that more studies are needed to understand older adults’ OHIS behaviors and better support their medical and health decisions in OHIS. Based on the results, the review proposes multiple objectives for future studies, including (1) more investigations on the OHIS behavior of older adults above 85 years; (2) conducting more longitudinal, action research, and mixed methods studies; (3) elaboration of the mobile context and cross-platform scenario of older adults’ OHIS; (4) facilitating older adults’ OHIS by explicating technology affordance; and (5) promoting and measuring the performance of OHIS interventions for older adults.

Frequency of Online Health Information Seeking and Types of Information Sought Among the General Chinese Population: Cross-sectional Study

BACKGROUND

The internet is one of the most popular health information resources, and the Chinese constitute one-fifth of the online users worldwide. As internet penetration continues to rise, more details on the Chinese population seeking online health information need to be known based on the current literature.

OBJECTIVE

This study aims to explore the sociodemographic differences in online health information seeking (OHIS), including the frequency of OHIS and the types of online health information sought among the general Chinese population in mainland China.

METHODS

A cross-sectional study for assessing the residents' health care needs with self-administered questionnaires was implemented in 4 counties and districts in China from July 2018 to August 2018. Pearson's chi-square test was used to identify the sociodemographic differences between infrequent and frequent online health information seekers. We also performed binary logistic regression for the 4 types of online health information as the dependent variables and the sociodemographic factors as the independent variables.

RESULTS

Compared with infrequent online health information seekers, frequent seekers were more likely to be female (infrequent: 1654/3318; 49.85%; frequent: 1015/1831, 55.43%), older (over 60 years old; infrequent: 454/3318, 13.68%; frequent: 282/1831, 15.40%), married (infrequent: 2649/3318, 79.84%; frequent: 1537/1831, 83.94%), and better educated (bachelor's or above; infrequent: 834/3318, 25.14%; frequent: 566/1831, 30.91%). They were also more likely to earn a higher income (over RMB ¥50k [RMB ¥1=US $0.15641]; infrequent: 1139/3318, 34.33%; frequent: 710/1831, 34.78%), have commercial health insurance (infrequent: 628/3318, 18.93%; frequent: 470/1831, 25.67%), and have reported illness in the past 12 months (infrequent: 659/3318, 19.86%; frequent: 415/1831, 22.67%). Among the 4 health information types, health science popularization was the most searched for information by Chinese online health information seekers (3654/5149, 70.79%), followed by healthy behaviors (3567/5149, 69.28%), traditional Chinese medicine (1931/5149, 37.50%), and medical concerns (1703/5149, 33.07%). The binary logistic regression models showed that males were less likely to seek information on healthy behaviors (adjusted odds ratio [AOR] 0.69, 95% CI 0.61-0.78) and traditional Chinese medicine (AOR 0.64, 95% CI 0.57-0.73), and respondents who had at least 1 chronic disease were more likely to seek information on medical concerns (AOR 1.27, 95% CI 1.07-1.51) and traditional Chinese medicine (AOR 1.26, 95% CI 1.06-1.49).

CONCLUSIONS

Sociodemographic factors were associated with the frequency of OHIS and types of information sought among the general Chinese population. The results remind providers of online health information to consider the needs of specific population groups when tailoring and presenting health information to the target population.

Conceptualizations of Cyberchondria and Relations to the Anxiety Spectrum: Systematic Review and Meta-analysis

BACKGROUND

Cyberchondria describes the detrimental effects of health-related internet use. Current conceptualizations agree that cyberchondria is associated with anxiety-related pathologies and may best be conceptualized as a safety behavior; however, little is known about its exact underlying mechanisms.

OBJECTIVE

This systematic review and meta-analysis aims to give an overview of the conceptualizations of cyberchondria and its relation to anxiety-related pathologies, quantify the strength of association to health anxiety by using meta-analyses, highlight gaps in the literature, and outline a hypothetical integrative cognitive-behavioral model of cyberchondria based on the available empirical evidence.

METHODS

A systematic literature search was conducted using PubMed, Web of Science, and PsycINFO electronic databases. A total of 25 studies were included for qualitative synthesis and 7 studies, comprising 3069 individuals, were included for quantitative synthesis. The meta-analysis revealed a strong association of cyberchondria (r=0.63) and its subfacets (r=0.24-0.66) with health anxiety.

RESULTS

The results indicate that cyberchondria is a distinct construct related to health anxiety, obsessive-compulsive symptoms, intolerance of uncertainty, and anxiety sensitivity. Further studies should distinguish between state and trait markers of anxiety-related pathologies and use experimental and naturalistic longitudinal designs to differentiate among risk factors, triggers, and consequences related to cyberchondria.

CONCLUSIONS

Health-related internet use in the context of health anxiety is best conceptualized as health-related safety behavior maintained through intermittent reinforcement. Here, we present a corresponding integrative cognitive-behavioral model.

Examining the Trends in Online Health Information-Seeking Behavior About Chronic Obstructive Pulmonary Disease in Singapore: Analysis of Data From Google Trends and the Global Burden of Disease Study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally, and timely health care seeking is imperative for its prevention, early detection, and management. While online health information-seeking behavior (OHISB) is increasingly popular due to widespread internet connectivity, little is known about how OHISB for COPD has changed in comparison with the COPD disease burden, particularly at a country-specific level.

OBJECTIVE

This study aimed to examine the trends in OHISB for COPD and how that compared with the estimates of COPD disease burden in Singapore, a highly wired country with a steadily increasing COPD disease burden.

METHODS

To examine the trends in OHISB for COPD, we performed Prais-Winsten regression analyses on monthly search volume data for COPD from January 2004 to June 2020 downloaded from Google Trends. We then conducted cross-correlational analyses to examine the relationship between annualized search volume on COPD topics and estimates of COPD morbidity and mortality reported in the Global Burden of Disease study from 2004 to 2017.

RESULTS

From 2004 to 2020, the trend in COPD search volume was curvilinear (β=1.69, t₁₉₄=6.64, P<.001), with a slope change around the end of 2006. There was a negative linear trend (β=-0.53, t₃₃=-3.57, P=.001) from 2004 to 2006 and a positive linear trend (β=0.51, t₁₅₉=7.43, P<.001) from 2007 to 2020. Cross-correlation analyses revealed positive associations between COPD search volume and COPD disease burden indicators: positive correlations between search volume and prevalence, incidence, years living with disability (YLD) at lag 0, and positive correlations between search volume and prevalence, YLD at lag 1.

CONCLUSIONS

Google search volume on COPD increased from 2007 to 2020; this trend correlated with the upward trajectory of several COPD morbidity estimates, suggesting increasing engagement in OHISB for COPD in Singapore. These findings underscore the importance of making high-quality, web-based information accessible to the public, particularly COPD patients and their carers.

Lifestyle Segmentation to Explain the Online Health Information-Seeking Behavior of Older Adults: Representative Telephone Survey

Background

As a result of demographic changes, the number of people aged 60 years and older has been increasing steadily. Therefore, older adults have become more important as a target group for health communication efforts. Various studies show that online health information sources have gained importance among younger adults, but we know little about the health-related internet use of senior citizens in general and in particular about the variables explaining their online health-related information–seeking behavior. Media use studies indicate that in addition to sociodemographic variables, lifestyle factors might play a role in this context.

Objective

The aim of this study was to examine older people’s health-related internet use. Our study focused on the explanatory potential of lifestyle types over and above sociodemographic variables to predict older adults’ internet use for health information.

Methods

A telephone survey was conducted with a random sample of German adults aged 60 years and older (n=701) that was quota-allocated by gender, age, educational status, and degree of urbanity of their place of residence.

Results

The results revealed that participants used the internet infrequently (mean 1.82 [SD 1.07]), and medical personnel (mean 2.89 [SD 1.11]), family and friends (mean 2.86 [SD 1.21]), and health brochures (mean 2.85 [SD 1.21]) were their main sources of health information. A hierarchical cluster analysis based on values, interests, and leisure time activities revealed three different lifestyle types for adults aged over 60 years: the Sociable Adventurer, the Average Family Person, and the Uninterested Inactive. After adding these types as second-step predictors in a hierarchical regression model with sociodemographic variables (step 1), the explained variance increased significantly (R²=.02, P=.001), indicating that the Average Family Person and the Sociable Adventurer use the internet more often for health information than the Uninterested Inactive, over and above their sociodemographic attributes.

Conclusions

Our findings indicate that the internet still plays only a minor role in the health information–seeking behavior of older German adults. Nevertheless, there are subgroups including younger, more active, down-to-earth and family-oriented males that may be reached with online health information. Our findings suggest that lifestyle types should be taken into account when predicting health-related internet use behavior.

Profiles of a Health Information-Seeking Population and the Current Digital Divide: Cross-Sectional Analysis of the 2015-2016 California Health Interview Survey

Background

Internet use for health information is important, given the rise of electronic health (eHealth) that integrates technology into health care. Despite the perceived widespread use of the internet, a persistent “digital divide” exists in which many individuals have ready access to the internet and others do not. To date, most published reports have compared characteristics of internet users seeking health information vs nonusers. However, there is little understanding of the differences between internet users seeking health information online and users who do not seek such information online. Understanding these differences could enable targeted outreach for health interventions and promotion of eHealth technologies.

Objective

This study aims to assess population-level characteristics associated with different types of internet use, particularly for seeking online health information.

Methods

The 2015-2016 California Health Interview Survey datasets were used for this study. Internet use was classified as never used the internet (Never use), ever used the internet but not to search for health information in the last 12 months (Use not for health), and ever used the internet and have used it to search for health information in the last 12 months (Use for health). Weighted multinomial logistic regression was used to assess sociodemographic and health characteristics associated with types of internet use. Findings are reported as odds ratios (ORs) with 95% CIs.

Results

Among 42,087 participants (weighted sample of 29,236,426), 19% reported Never Use of the internet, 27.9% reported Use not for health, and 53.1% reported Use for health. Compared to Never Use individuals, Use for health individuals were more likely to be younger (OR: 0.1, 95% CI 0.1-0.2 for ≥60 years vs <60 years), female (OR: 1.6, 95% CI 1.3-1.9 compared to males), and non-Hispanic white (OR: 0.54, 95% CI 0.4-0.7 for Latinos and OR: 0.2, 95% CI 0.2-0.4 for African Americans) and have a higher socioeconomic status (>400% of Federal Poverty Guidelines; OR: 1.3, 95% CI 1.4-2.4). Overall, characteristics for the Use not for health and Use for health groups were similar, except for those with lower levels of education and respondents not having visited a physician in the last year. For these two characteristics, the Use not for health group was more similar to the Never Use group.

Conclusions

Our findings indicate that a digital divide characterized by sociodemographic and health information exists across three types of users. Our results are in line with those of previous studies on the divide, specifically with regard to disparities in use and access related to age, race/ethnicity, and socioeconomic status. Disparities in online health-seeking behavior may reflect existing disparities in health care access extending into a new era of health technology. These findings support the need for interventions to target internet access and health literacy among Never Use and Use not for health groups.

Online Health Information Seeking and eHealth Literacy Among Patients Attending a Primary Care Clinic in Hong Kong: A Cross-Sectional Survey

Background

Previous studies have suggested that patients’ online health information seeking affects their medical consultations and patient-doctor relationships. An up-to-date picture of patients’ online health information-seeking behaviors can inform and prepare frontline health care professionals to collaborate, facilitate, or empower their patients to access and manage health information found online.

Objective

This study explores the prevalence, patterns, and predictors of online health information-seeking behaviors among primary care patients in Hong Kong, and the relations between online health information seeking and electronic health (eHealth) literacy.

Methods

Patients attending a university primary care clinic in Hong Kong were asked to complete a questionnaire survey on their demographic backgrounds; health status; frequency and pattern of online health information seeking; contents, sources, and reasons for online health information seeking; and their eHealth literacy. eHealth literacy was measured by the validated eHealth Literacy Scale (eHEALS). Regression analyses explored various demographic and behavioral predictors to online health information seeking, and predictors to eHealth literacy.

Results

In all, 97.32% (1162/1194) respondents used the internet, of which 87.44% (1016/1162) had used the internet to find health information. Most respondents (65.97%, 665/1008) searched once monthly or more. Few (26.88%, 271/1008) asked their doctor about health information found online, but most doctors (56.1%, 152/271) showed little or no interest at all. The most sought topic was symptom (81.59%, 829/1016), the top reason was noticing new symptoms or change in health (70.08%, 712/1016), the most popular source was online encyclopedia (69.98%, 711/1016), and the top reason for choosing a source was convenience (55.41%, 563/1016). Poisson regression analysis identified high eHEALS score, fair or poor self-rated health, having a chronic medical condition, and using the internet several times a day as significant predictors of online health information seeking. Multiple regression analysis identified lower age, better self-rated health, more frequent internet use, more frequent online health information seeking, and more types of health information sought as significant predictors to higher eHealth literacy.

Conclusions

Online health information seeking is prevalent among primary care patients in Hong Kong, but only a minority shared the information with doctors. Websites were chosen more for convenience than for accuracy or authoritativeness. Doctors should recognize patients’ online health information-seeking behavior, and facilitate and empower them to search for high-quality online health information.

Types and Factors Associated With Online Health Information Seeking Among College Men in Latino Fraternities: A Qualitative Study

Despite the fact that a large percentage of Americans go online to seek health information, literature pertaining to online health information (OHI) seeking among college men in Latino fraternities (CMLF) has been nonexistent. Thus, the purpose of this study was to (a) identify the types of OHI that CMLF seek and (b) to determine the factors motivating OHI seeking among CMLF. Four 1- to 1.5-hour focus groups were conducted in two public universities in Florida with 41 college-aged Latino males in an established Latino fraternity. E-mails were used to recruit fraternity members. Qualitative analysis of the focus group transcripts identified that CMLF search for a variety of OHI types including searches on symptoms, diagnoses, weight loss, and treatments for conditions or diseases among other types of OHI. Factors motivating OHI seeking included informational needs of others and concerns for others, worries due to lack of health insurance, preoccupations with health condition, concerns over physical appearance, and clarification through social media. CMLF may be elicited to serve as information conduits to increase access to health information on chronic diseases for older non-English-speaking Latino adults. Lack of health insurance along with other factors in this segment of the population have led to self-diagnosis and self-treatment of illness. Thus, empirical research and health promotion on the potential risks due to self-diagnosing and self-treatment of illness is warranted among CMLF.

The Prevalence of Online Health Information Seeking Among Patients in Scotland: A Cross-Sectional Exploratory Study

BACKGROUND

Online health information seeking is an activity that needs to be explored in Scotland. While there are a growing number of studies that adopt a qualitative approach to this issue and attempt to understand the behaviors associated with online health information seeking, previous studies focusing on quantifying the prevalence and pattern of online health seeking in the United Kingdom have been based on Internet users in general.

OBJECTIVE

This exploratory study sought to describe the prevalence of online health information seeking in a rural area of Scotland based on primary data from a patient population.

METHODS

A survey design was employed utilizing self-completed questionnaires, based on the Pew Internet and American Life Project; questionnaires were distributed among adult patients in 10 primary care centers in a rural community in Scotland.

RESULTS

A convenience sample of 571 (0.10% of the total population in Grampian, N=581,198) patients completed the questionnaire. A total of 68.4% (379/554) of patients had previously used the Internet to acquire health information. A total of 25.4% (136/536) of patients consulted the Internet for health information regarding their current appointment on the day surveyed; 34.6% (47/136) of these patients were influenced to attend their appointment as a result of that online health information. A total of 43.2% (207/479) of patients stated the health information helped improve their health and 67.1% (290/432) indicated that they had learned something new. A total of 34.0% (146/430) of patients talked to a health professional about the information they had found and 90.0% (376/418) reported that the information was useful. In total, 70.4% (145/206) of patients were concerned about obtaining health information online from reliable sources. A total of 67.1% (139/207) of patients were concerned that a health site may sell their personal information, yet only 6.7% (36/535) checked the privacy policy of the site visited. However, 27.9% (55/197) of patients were not concerned about their employer finding out what health sites they visited, whereas 37.5% (78/208) were concerned that others would find out.

CONCLUSIONS

The results suggest that online health information-seeking behavior influences offline health-related behavior among the population surveyed. Patient attitudes to online health information seeking were focused on issues relating to trust, reliability, privacy, and confidentiality. This study provides support for the growing phenomenon of an empowered, computer-literate, health information consumer, and the impact of this phenomenon must be considered in the context of the patient-health professional dynamic. The unpredictable nature of human thought and action in relation to this field of study requires an ongoing program of ethnographic research, both physical and virtual, within a Health Web Science framework. This study has provided a baseline of the prevalence of online health information seeking in the Grampian region of Scotland.

Patient perspectives on online health information and communication with doctors: a qualitative study of patients 50 years old and over

Background

As health care systems around the world shift toward models that emphasize self-care management, there is increasing pressure for patients to obtain health information online. It is critical that patients are able to identify potential problems with using the Internet to diagnose and treat a health issue and that they feel comfortable communicating with their doctor about the health information they acquire from the Internet.

Objective

Our aim was to examine patient-identified (1) problems with using the Internet to identify and treat a health issue, (2) barriers to communication with a doctor about online health information seeking, and (3) facilitators of communication with a doctor about patient searches for health information on the Internet.

Methods

For this qualitative exploratory study, semistructured interviews were conducted with a sample of 56 adults age 50 years old and over. General concerns regarding use of the Internet to diagnose and treat a health issue were examined separately for participants based on whether they had ever discussed health information obtained through the Internet with a doctor. Discussions about barriers to and facilitators of communication about patient searches for health information on the Internet with a doctor were analyzed using thematic analysis.

Results

Six higher-level general concerns emerged: (1) limitations in own ability, (2) credibility/limitations of online information, (3) anxiety, (4) time consumption, (5) conflict, and (6) non-physical harm. The most prevalent concern raised by participants who communicated with a doctor about their online health information seeking related to the credibility or limitations in online information. Participants who had never communicated with a doctor about their online health information seeking most commonly reported concerns about non-physical harm. Four barriers to communication emerged: (1) concerns about embarrassment, (2) concerns that the doctor doesn’t want to hear about it, (3) belief that there is no need to bring it up, and (4) forgetting to bring it up. Facilitators of communication included: (1) having a family member present at doctor visits, (2) doctor-initiated inquiries, and (3) encountering an advertisement that suggested talking with a doctor.

Conclusions

Overall, participants displayed awareness of potential problems related to online health information seeking. Findings from this study point to a set of barriers as well as facilitators of communication about online health information seeking between patients and doctors. This study highlights the need for enhanced patient communication skills, eHealth literacy assessments that are accompanied by targeted resources pointing individuals to high-quality credible online health information, and the need to remind patients of the importance of consulting a medical professional when they use online health resources to diagnose and treat a health issue.

Predictors of Self and Surrogate Online Health Information Seeking in Family Caregivers to Cancer Survivors

The purpose of this research is to investigate various factors predicting online health information seeking for themselves (self OHIS) and online health information seeking for others (surrogate OHIS) in family caregivers to cancer survivors. To address this purpose, this study applies the comprehensive model of information seeking as a theoretical framework for explaining the relationships between various predictors and two types of OHIS. The data used in this study were taken from the Health Information National Trends Survey 4. A total of 1,113 family caregivers were included in this study. Logistic regression analyses were conducted to examine the effects of predictors on Internet use for health information seeking. Caregivers' self and surrogate OHIS were commonly predicted by their self-rated health and attention to the Internet. However, age, race, and education were significantly associated with self OHIS only, while gender and marital status were significantly associated with surrogate OHIS only. These results suggest that family caregivers' self and surrogate OHIS are predicted by common factors, as well as predicted by different specific factors.

Examining the relationships between resources and online health information seeking among patients with chronic diseases and healthy people

The Internet is increasingly used as an important source of health and medical-related information for people with chronic diseases. It is recognized that online health information seeking (OHIS) is influenced by individuals' multi-dimensional factors, such as demographics, socio-economic factors, perceptions of the Internet, and health conditions. This study applies the conservation of resource theory to examine relationships between various multi-dimensional factors, daily challenges, and OHIS depending on individuals' health conditions. The data used in this study was taken from the U.S. Health Tracking Survey (2012). In this study, Internet users aged 18 and older were classified into patients (N = 518) and healthy people (N = 677) based on their health status related to chronic diseases. Multiple regression analysis was used to examine the relationships between multi-dimensional factors (resources), self-rated health, and OHIS. Patients' various resources (e.g., age, income, education, having a smartphone, and health tracking) significantly predicted their self-rated health and OHIS; in addition, self-rated health significantly mediated the relationships between focal resources and OHIS. However, the mediating effects of self-rated health were not found in healthy people.

Dr Google and the consumer: a qualitative study exploring the navigational needs and online health information-seeking behaviors of consumers with chronic health conditions

BACKGROUND

The abundance of health information available online provides consumers with greater access to information pertinent to the management of health conditions. This is particularly important given an increasing drive for consumer-focused health care models globally, especially in the management of chronic health conditions, and in recognition of challenges faced by lay consumers with finding, understanding, and acting on health information sourced online. There is a paucity of literature exploring the navigational needs of consumers with regards to accessing online health information. Further, existing interventions appear to be didactic in nature, and it is unclear whether such interventions appeal to consumers' needs.

OBJECTIVE

Our goal was to explore the navigational needs of consumers with chronic health conditions in finding online health information within the broader context of consumers' online health information-seeking behaviors. Potential barriers to online navigation were also identified.

METHODS

Semistructured interviews were conducted with adult consumers who reported using the Internet for health information and had at least one chronic health condition. Participants were recruited from nine metropolitan community pharmacies within Western Australia, as well as through various media channels. Interviews were audio-recorded, transcribed verbatim, and then imported into QSR NVivo 10. Two established approaches to thematic analysis were adopted. First, a data-driven approach was used to minimize potential bias in analysis and improve construct and criterion validity. A theory-driven approach was subsequently used to confirm themes identified by the former approach and to ensure identified themes were relevant to the objectives. Two levels of analysis were conducted for both data-driven and theory-driven approaches: manifest-level analysis, whereby face-value themes were identified, and latent-level analysis, whereby underlying concepts were identified.

RESULTS

We conducted 17 interviews, with data saturation achieved by the 14th interview. While we identified a broad range of online health information-seeking behaviors, most related to information discussed during consumer-health professional consultations such as looking for information about medication side effects. The barriers we identified included intrinsic barriers, such as limited eHealth literacy, and extrinsic barriers, such as the inconsistency of information between different online sources. The navigational needs of our participants were extrinsic in nature and included health professionals directing consumers to appropriate online resources and better filtering of online health information. Our participants' online health information-seeking behaviors, reported barriers, and navigational needs were underpinned by the themes of trust, patient activation, and relevance.

CONCLUSIONS

This study suggests that existing interventions aimed to assist consumers with navigating online health information may not be what consumers want or perceive they need. eHealth literacy and patient activation appear to be prevalent concepts in the context of consumers' online health information-seeking behaviors. Furthermore, the role for health professionals in guiding consumers to quality online health information is highlighted.

Comparative analysis of online health queries originating from personal computers and smart devices on a consumer health information portal

Background

The number of people using the Internet and mobile/smart devices for health information seeking is increasing rapidly. Although the user experience for online health information seeking varies with the device used, for example, smart devices (SDs) like smartphones/tablets versus personal computers (PCs) like desktops/laptops, very few studies have investigated how online health information seeking behavior (OHISB) may differ by device.

Objective

The objective of this study is to examine differences in OHISB between PCs and SDs through a comparative analysis of large-scale health search queries submitted through Web search engines from both types of devices.

Methods

Using the Web analytics tool, IBM NetInsight OnDemand, and based on the type of devices used (PCs or SDs), we obtained the most frequent health search queries between June 2011 and May 2013 that were submitted on Web search engines and directed users to the Mayo Clinic’s consumer health information website. We performed analyses on “Queries with considering repetition counts (QwR)” and “Queries without considering repetition counts (QwoR)”. The dataset contains (1) 2.74 million and 3.94 million QwoR, respectively for PCs and SDs, and (2) more than 100 million QwR for both PCs and SDs. We analyzed structural properties of the queries (length of the search queries, usage of query operators and special characters in health queries), types of search queries (keyword-based, wh-questions, yes/no questions), categorization of the queries based on health categories and information mentioned in the queries (gender, age-groups, temporal references), misspellings in the health queries, and the linguistic structure of the health queries.

Results

Query strings used for health information searching via PCs and SDs differ by almost 50%. The most searched health categories are “Symptoms” (1 in 3 search queries), “Causes”, and “Treatments & Drugs”. The distribution of search queries for different health categories differs with the device used for the search. Health queries tend to be longer and more specific than general search queries. Health queries from SDs are longer and have slightly fewer spelling mistakes than those from PCs. Users specify words related to women and children more often than that of men and any other age group. Most of the health queries are formulated using keywords; the second-most common are wh- and yes/no questions. Users ask more health questions using SDs than PCs. Almost all health queries have at least one noun and health queries from SDs are more descriptive than those from PCs.

Conclusions

This study is a large-scale comparative analysis of health search queries to understand the effects of device type (PCs vs SDs) used on OHISB. The study indicates that the device used for online health information search plays an important role in shaping how health information searches by consumers and patients are executed.