%0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23892 %T Acceptability, Safety, and Resonance of the Pilot Digital Suicide Prevention Campaign “Better Off With You”: Qualitative Study %A Carrotte,Elise Rose %A Webb,Marianne %A Flego,Anna %A Vincent,Bonnie %A Heath,Jack %A Blanchard,Michelle %+ Anne Deveson Research Centre, SANE Australia, PO Box 226, South Melbourne, 3205, Australia, 61 3 9682 5933, elise.carrotte@sane.org %K suicide %K interpersonal theory of suicide %K social media %K co-design %K lived experience %D 2021 %7 3.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Interpersonal Theory of Suicide posits that there are three key elements of suicidal behavior: perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. The digital campaign Better Off With You was developed to directly challenge the idea of perceived burdensomeness among people who are contemplating suicide in 2 communities within Australia. Objective: The aim of this study is to explore the needs and preferences of people with lived experience of suicidal thoughts and actions to inform the development of Better Off With You. Methods: This study involved a series of focus groups that aimed to discuss campaign messaging, scope, and approach. People with lived experience of suicidal thoughts and actions attended the focus groups. After the completion of initial focus groups, the results informed the creation of campaign collateral by creative agencies. Early versions of the campaign collateral were then presented in the user testing sessions. Transcriptions were analyzed via thematic analysis. Results: In total, 13 participants attended the focus groups and 14 attended the user testing sessions. The following three overarching themes were presented: acceptability, safety, and resonance. Participants believed that suicide is a serious and ongoing issue in their communities and welcomed a localized suicide prevention focus via peer-to-peer storytelling. The idea of perceived burdensomeness required clarification but was perceived as acceptable and relevant. Participants seemed drawn toward peer narratives that they perceived to be authentic, genuine, and believable as given by real people with lived experience. Campaign messaging needs to be clear and empathetic while directly talking about suicide. Participants did not anticipate any significant negative or harmful impact from any campaign videos and highlighted the importance of providing appropriate help-seeking information. Conclusions: This iterative study provided important insights and knowledge about peer-to-peer storytelling in suicide prevention campaigns. Future campaigns should involve simple messaging, be validating and empathetic, and consider including a lived experience perspective. %M 33656441 %R 10.2196/23892 %U https://formative.jmir.org/2021/3/e23892 %U https://doi.org/10.2196/23892 %U http://www.ncbi.nlm.nih.gov/pubmed/33656441 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21156 %T COVID-19–Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results %A Geronikolou,Styliani %A Chrousos,George %+ University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Levadias 1, Athens, Greece, 30 2132013362, sgeronik@gmail.com %K COVID-19 %K social media %K misinformation %K infodemics %K infodemiology %K infoveillance %K fear %K meta-analysis %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization named the phenomenon of misinformation spread through social media as an “infodemic” and recognized the need to curb it. Misinformation infodemics undermine not only population safety but also compliance to the suggestions and prophylactic measures recommended during pandemics. Objective: The aim of this pilot study is to review the impact of social media on general population fear in “infoveillance” studies during the COVID-19 pandemic. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol was followed, and 6 out of 20 studies were retrieved, meta-analyzed, and had their findings presented in the form of a forest plot. Results: The summary random and significant event rate was 0.298 (95% CI 0.213-0.400), suggesting that social media–circulated misinformation related to COVID-19 triggered public fear and other psychological manifestations. These findings merit special attention by public health authorities. Conclusions: Infodemiology and infoveillance are valid tools in the hands of epidemiologists to help prevent dissemination of false information, which has potentially damaging effects. %M 33400681 %R 10.2196/21156 %U https://formative.jmir.org/2021/2/e21156 %U https://doi.org/10.2196/21156 %U http://www.ncbi.nlm.nih.gov/pubmed/33400681 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e15858 %T The Relationship Between Individual Coping and the Need to Have and Seek Health Information Among Older Adults: Exploratory Mixed Methods Study %A Theis,Sabine %A Schäfer,Katharina %A Schäfer,Dajana %A Jochems,Nicole %A Nitsch,Verena %A Mertens,Alexander %+ Institut für Arbeitswissenschaft, RWTH Aachen University, Eilfschornsteinstraße 18, Aachen, 52062, Germany, 49 241809946, s.theis@iaw.rwth-aachen.de %K health %K information science %K systems analysis %K eHealth %K engineering %K gerontology %K information technology %K mobile phone %D 2021 %7 1.2.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The need to have and seek information shapes the context of computing systems. When it comes to health, individual coping influences human behavior. Therefore, the relationship between individual coping and the need to have and seek health information plays a crucial role in the development of digital health systems. Objective: This study aims to examine the relationship between individual coping and the need to have and seek health information among older adults. Methods: Questionnaires and semistructured interviews investigated the health information need (HIN) and health information–seeking behavior (HISB) in relation to the individual coping strategies of 26 older Germans. Results: The mean age of the interviewed group was 71 years (SD 7). Quantitatively, a trend was found for a negative correlation between the avoidance-oriented coping and HIN (rs=−0.37895; bias-corrected and accelerated bootstrap 95% BCa CI −0.730 to 0.092; P=.05). The qualitative results supported this finding. For some participants, information and exchange was part of dealing with their health situation, whereas others wanted to learn as little as possible to avoid a decline in their health status. The older adults acquired, collected, and exchanged paper-based health data to augment clinical information sources and support information exchange with professionals. Conclusions: Individual coping strategies are relevant for the design of digital health systems. They can support older adults in coping with their health situation, although it remains unclear how systems must be designed for people with an avoidance coping strategy to achieve the same acceptance. %M 33522973 %R 10.2196/15858 %U https://humanfactors.jmir.org/2021/1/e15858 %U https://doi.org/10.2196/15858 %U http://www.ncbi.nlm.nih.gov/pubmed/33522973 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e17782 %T The Causal Relationship Between Portal Usage and Self-Efficacious Health Information–Seeking Behaviors: Secondary Analysis of the Health Information National Trends Survey Data %A Park,Jaeyoung %A Liang,Muxuan %A Alpert,Jordan M %A Brown,Richard F %A Zhong,Xiang %+ Department of Industrial and Systems Engineering, University of Florida, PO Box 115002, Gainesville, FL, 32611, United States, 1 3523922477, xiang.zhong@ise.ufl.edu %K causal inference %K instrumental variable %K directed acyclic graph %K patient portal %K self-efficacy %D 2021 %7 27.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient portals have drawn much attention, as they are considered an important tool for health providers in facilitating patient engagement. However, little is known about whether the intensive use of patient portals contributes to improved management of patients’ health in terms of their confidence in acquiring health information and exercising self-care. There is a lack of randomized trials with these outcomes measured both pre- and postadoption of patient portals. Objective: The aim of this study was to examine the causal relationship between the usage of patient portals and patients’ self-efficacy toward obtaining health information and performing self-care. Methods: This study was a secondary data analysis that used data from a US national survey, the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 1. Patient portal usage frequency was used to define the treatment. Survey items measuring self-efficacy on a Likert-type scale were selected as the main outcomes, including patients’ confidence in obtaining health information and performing self-care. To establish causality using survey data, we adopted the instrumental variables method. To determine the direction of the causal relationship in the presence of high-dimensional confounders, we further proposed a novel testing framework that employs conditional independence tests in a directed acyclic graph. The average causal effect was measured using the two-stage least squares regression method. Results: We showed that frequently using patient portals improves patients’ confidence in obtaining health information. The estimand of the weighted average causal effect was 0.14 (95% CI 0.06-0.23; P<.001). This means that when increasing the portal usage intensity, for instance, from 1-2 times to 3-5 times per year, the expected average increase in confidence level measured on a Likert-type scale would be 0.14. However, we could not conclusively determine the causal effect between patient portal usage and patients’ confidence in exercising self-care. Conclusions: The results support the use of patient portals and encourage better support and education to patients. The proposed statistical method can be used to exploit the potential of national survey data for causal inference studies. %M 33502334 %R 10.2196/17782 %U http://www.jmir.org/2021/1/e17782/ %U https://doi.org/10.2196/17782 %U http://www.ncbi.nlm.nih.gov/pubmed/33502334 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e14088 %T Role of Health Literacy in Health-Related Information-Seeking Behavior Online: Cross-sectional Study %A Lee,Hee Yun %A Jin,Seok Won %A Henning-Smith,Carrie %A Lee,Jongwook %A Lee,Jaegoo %+ Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, United States, 1 617 432 1232, jongwook_lee@hsph.harvard.edu %K digital divide %K health literacy %K internet %K technology %K access %D 2021 %7 27.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet has emerged as a main venue of health information delivery and health-related activities. However, few studies have examined how health literacy determines online health-related behavior. Objective: The aim of this study was to investigate the current level of health-related information-seeking using the internet and how health literacy, access to technology, and sociodemographic characteristics impact health-related information-seeking behavior. Methods: We conducted a cross-sectional study through a survey with Minnesotan adults (N=614) to examine their health literacy, access to technology, and health-related information-seeking internet use. We used multivariate regression analysis to assess the relationship between health-related information-seeking on the internet and health literacy and access to technology, controlling for sociodemographic characteristics. Results: Better health literacy (β=.35, SE 0.12) and greater access to technological devices (eg, mobile phone and computer or tablet PC; β=.06, SE 0.19) were both associated with more health-related information-seeking behavior on the internet after adjusting for all other sociodemographic characteristics. Possession of a graduate degree (β=.28, SE 0.07), female gender (β=.15, SE 0.05), poor health (β=.22, SE 0.06), participation in social groups (β=.13, SE 0.05), and having an annual health exam (β=.35, SE 0.12) were all associated with online health-related information-seeking. Conclusions: Our findings indicate that access to online health-related information is not uniformly distributed throughout the population, which may exacerbate disparities in health and health care. Research, policy, and practice attention are needed to address the disparities in access to health information as well as to ensure the quality of the information and improve health literacy. %M 33502332 %R 10.2196/14088 %U http://www.jmir.org/2021/1/e14088/ %U https://doi.org/10.2196/14088 %U http://www.ncbi.nlm.nih.gov/pubmed/33502332 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e25413 %T Patient-Generated Health Data in Pediatric Asthma: Exploratory Study of Providers' Information Needs %A Tiase,Victoria L %A Sward,Katherine A %A Del Fiol,Guilherme %A Staes,Catherine %A Weir,Charlene %A Cummins,Mollie R %+ The Value Institute, New York–Presbyterian Hospital, 525 East 68th Street, New York, NY, United States, 1 212 305 8865, vtiase@nyp.org %K information needs %K asthma %K symptom management %K mobile health %K patient-generated health data %K pediatrics %K adolescents %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescents are using mobile health apps as a form of self-management to collect data on symptoms, medication adherence, and activity. Adding functionality to an electronic health record (EHR) to accommodate disease-specific patient-generated health data (PGHD) may support clinical care. However, little is known on how to incorporate PGHD in a way that informs care for patients. Pediatric asthma, a prevalent health issue in the United States with 6 million children diagnosed, serves as an exemplar condition to examine information needs related to PGHD. Objective: In this study we aimed to identify and prioritize asthma care tasks and decisions based on pediatric asthma guidelines and identify types of PGHD that might support the activities associated with the decisions. The purpose of this work is to provide guidance to mobile health app developers and EHR integration. Methods: We searched the literature for exemplar asthma mobile apps and examined the types of PGHD collected. We identified the information needs associated with each decision in accordance with consensus-based guidelines, assessed the suitability of PGHD to meet those needs, and validated our findings with expert asthma providers. Results: We mapped guideline-derived information needs to potential PGHD types and found PGHD that may be useful in meeting information needs. Information needs included types of symptoms, symptom triggers, medication adherence, and inhaler technique. Examples of suitable types of PGHD were Asthma Control Test calculations, exposures, and inhaler use. Providers suggested uncontrolled asthma as a place to focus PGHD efforts, indicating that they preferred to review PGHD at the time of the visit. Conclusions: We identified a manageable list of information requirements derived from clinical guidelines that can be used to guide the design and integration of PGHD into EHRs to support pediatric asthma management and advance mobile health app development. Mobile health app developers should examine PGHD information needs to inform EHR integration efforts. %M 33496674 %R 10.2196/25413 %U http://pediatrics.jmir.org/2021/1/e25413/ %U https://doi.org/10.2196/25413 %U http://www.ncbi.nlm.nih.gov/pubmed/33496674 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e25474 %T Awareness, Information-Seeking Behavior, and Information Preferences About Early Childhood Allergy Prevention Among Different Parent Groups: Protocol for a Mixed Methods Study %A Lander,Jonas %A Curbach,Janina %A von Sommoggy,Julia %A Bitzer,Eva Maria %A Dierks,Marie-Luise %+ Hanover Medical School, Carl-Neuberg-Str 1, Hanover, 30625, Germany, 49 5115324450, lander.jonas@mh-hannover.de %K health literacy %K allergy prevention %K children %K health information %K parents %D 2021 %7 20.1.2021 %9 Original Paper %J JMIR Res Protoc %G English %X Background: In early childhood allergy prevention (ECAP), parents act on behalf of their children. Parental health literacy and the availability of high-quality information, both online and offline, are crucial for effective ECAP. Recent research highlights three main points. First, parents need sufficient health literacy to discriminate between high-quality and low-quality information. Second, ECAP information behaviors may vary between phases of childhood development and according to individual circumstances. Third, to strengthen user-centeredness of available services, a better overview of parents’ information practices and needs and how they handle uncertainties is required. Objective: This study aims to explore why, how, and when parents search for and apply ECAP-specific health information and which individual (eg, understanding of advice) and organizational challenges (eg, information services, information complexity, and changing recommendations) they perceive and how they handle them. This study also aims to assess the needs and preferences that parents express for future information formats and contents. The findings should inform the practical design of ECAP information as well as formats and channels specific to different parent groups. Methods: The above-named issues will be explored with parents in four German cities as one element in our efforts to cover the spectrum of perspectives. Based on a mixed methods design, including qualitative and quantitative assessments, the first year serves to prepare focus groups, a piloted focus group guide, a short standardized survey adapted from the European Health Literacy Project, recruitment channels, and the recruitment of participants. After conducting 20 focus groups in the second year, data will be analyzed via a constant comparison method in the third year. Based on this, practice implications on channels (ie, Where?), formats (ie, How?), and contents (ie, What?) of ECAP-specific information will be derived and discussed with parents and associated project partners before its dissemination to relevant ECAP actors (eg, childcare institutions and pediatricians). Results: The study began with preselection of recruitment channels, drafting of recruitment and study information for potential participants, and agreement on a first full version of the guideline. Then, a detailed contact list was compiled of health professionals, administrative and social institutions, and relevant social media channels (N=386) to be approached for assistance in contacting parents. The recruitment was postponed due to COVID-19 and will start in January 2021. Conclusions: ECAP is a relevant example for assessing how users (ie, parents) handle not only health information but the various and continuous changes, uncertainties, and controversies attached to it. So far, it is unclear how parents implement the respective scientific recommendations and expert advice, which is why this study aims to inform those who communicate with parents about ECAP information. International Registered Report Identifier (IRRID): PRR1-10.2196/25474 %M 33470948 %R 10.2196/25474 %U http://www.researchprotocols.org/2021/1/e25474/ %U https://doi.org/10.2196/25474 %U http://www.ncbi.nlm.nih.gov/pubmed/33470948 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e14794 %T A Bayesian Network–Based Browsing Model for Patients Seeking Radiology-Related Information on Hospital Websites: Development and Usability Study %A Suzuki,Ryusuke %A Suzuki,Teppei %A Tsuji,Shintaro %A Fujiwara,Kensuke %A Yamashina,Hiroko %A Endoh,Akira %A Ogasawara,Katsuhiko %+ Graduate School of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, Japan, 81 11 706 3409, oga@hs.hokudai.ac.jp %K web marketing %K internet %K hospitals %K radiology %K information-seeking behavior %D 2021 %7 19.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: An increasing number of people are visiting hospital websites to seek better services and treatments compared to the past. It is therefore important for hospitals to develop websites to meet the needs of their patients. However, few studies have investigated whether and how the current hospital websites meet the patient’s needs. Above all, in radiation departments, it may be difficult for patients to obtain the desired information regarding modality and diagnosis because such information is subdivided when described on a website. Objective: The purpose of this study is to suggest a hospital website search behavior model by analyzing the browsing behavior model using a Bayesian network from the perspective of one-to-one marketing. Methods: First, we followed the website access log of Hokkaido University Hospital, which was collected from September 1, 2016, to August 31, 2017, and analyzed the access log using Google Analytics. Second, we specified the access records related to radiology from visitor browsing pages and keywords. Third, using these resources, we structured 3 Bayesian network models based on specific patient needs: radiotherapy, nuclear medicine examination, and radiological diagnosis. Analyzing each model, this study considered why some visitors could not reach their desired page and improvements to meet the needs of visitors seeking radiology-related information. Results: The radiotherapy model showed that 74% (67/90) of the target visitors could reach their requested page, but only 2% (2/90) could reach the Center page where inspection information, one of their requested pages, is posted. By analyzing the behavior of the visitors, we clarified that connecting with the radiotherapy and radiological diagnosis pages is useful for increasing the proportion of patients reaching their requested page. Conclusions: We proposed solutions for patient web-browsing accessibility based on a Bayesian network. Further analysis is necessary to verify the accuracy of the proposed model in comparison to other models. It is expected that information provided on hospital websites will be improved using this method. %M 33464211 %R 10.2196/14794 %U https://www.jmir.org/2021/1/e14794 %U https://doi.org/10.2196/14794 %U http://www.ncbi.nlm.nih.gov/pubmed/33464211 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24097 %T Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study %A Dadaczynski,Kevin %A Okan,Orkan %A Messer,Melanie %A Leung,Angela Y M %A Rosário,Rafaela %A Darlington,Emily %A Rathmann,Katharina %+ Department of Nursing and Health Sciences, Fulda University of Applied Sciences, Leipziger Sraße 123, Fulda, 36037, Germany, 49 661 9640 6073, kevin.dadaczynski@pg.hs-fulda.de %K digital health %K literacy %K infodemic %K health information %K behaviour %K coronavirus %K COVID-19 %K university student %K student %K infodemiology %D 2021 %7 15.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital communication technologies are playing an important role in the health communication strategies of governments and public health authorities during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and on protective behaviors. In addition, the COVID-19 infodemic is spreading faster than the coronavirus itself, which interferes with governmental health-related communication efforts. This jeopardizes national public health containment strategies. Therefore, digital health literacy is a key competence to navigate web-based COVID-19–related information and service environments. Objective: This study aimed to investigate university students’ digital health literacy and web-based information-seeking behaviors during the early stages of the COVID-19 pandemic in Germany. Methods: A cross-sectional study among 14,916 university students aged ≥18 years from 130 universities across all 16 federal states of Germany was conducted using a web-based survey. Along with sociodemographic characteristics (sex, age, subjective social status), the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Web-based information-seeking behavior was investigated by examining the web-based sources used by university students and the topics that the students searched for in connection with COVID-19. Data were analyzed using univariate and bivariate analyses. Results: Across digital health literacy dimensions, the greatest difficulties could be found for assessing the reliability of health-related information (5964/14,103, 42.3%) and the ability to determine whether the information was written with a commercial interest (5489/14,097, 38.9%). Moreover, the respondents indicated that they most frequently have problems finding the information they are looking for (4282/14,098, 30.4%). When stratified according to sociodemographic characteristics, significant differences were found, with female university students reporting a lower DHLI for the dimensions of “information searching” and “evaluating reliability.” Search engines, news portals, and websites of public bodies were most often used by the respondents as sources to search for information on COVID-19 and related issues. Female students were found to use social media and health portals more frequently, while male students used Wikipedia and other web-based encyclopedias as well as YouTube more often. The use of social media was associated with a low ability to critically evaluate information, while the opposite was observed for the use of public websites. Conclusions: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key. %M 33395396 %R 10.2196/24097 %U http://www.jmir.org/2021/1/e24097/ %U https://doi.org/10.2196/24097 %U http://www.ncbi.nlm.nih.gov/pubmed/33395396 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e19349 %T Use of Technology to Access Health Information/Services and Subsequent Association With WASH (Water Access, Sanitation, and Hygiene) Knowledge and Behaviors Among Women With Children Under 2 Years of Age in Indonesia: Cross-sectional Study %A Niedfeldt,Heidi Jane %A Beckstead,Emmalene %A Chahalis,Emily %A Jensen,Mindy %A Reher,Britton %A Torres,Scott %A Rachmi,Cut Novianti %A Jusril,Hafizah %A Hall,Cougar %A West,Joshua H %A Crookston,Benjamin T %+ Department of Public Health, Brigham Young University, 2137 LSB, Provo, UT, 84602, United States, 1 801 422 3143, heidiniedfeldt@gmail.com %K technology %K defecation %K handwashing %K WASH %K stunting %D 2021 %7 14.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Water access, sanitation, and hygiene (WASH) remain a public health concern in Indonesia. Proper WASH practices can decrease risk of stunting, wasting, and disease in children under the age of 2. Objective: The purpose of our study is to examine if using technology to access health information and services among Indonesian women affects knowledge and behaviors regarding handwashing and defecation practices. Methods: Our study is an interview-based cross-sectional survey. Participants included 1734 mothers of children under 2 years of age. These women were randomly selected and interviewed as part of a 3-stage cluster sampling technique. Our study uses data regarding WASH knowledge which includes benefits of handwashing with soap, 5 critical times of handwashing, risks of open defecation, media of disease transmission, defecation locations, and risks of open defecation. Data regarding WASH behaviors were also included: handwashing with soap, type of latrine used at home, and where defecation took place. This investigation used adjusted and unadjusted logistic and linear regression models to determine differences in WASH outcomes between those who use technology to access health information and services and those who did not. Results: One result is that Indonesian women with children under 2 years of age who use technology to access health information and services are more likely to know the advantages of proper handwashing (odds ratio [OR] 2.603, 95% CI 1.666-4.067) and know the 5 critical times of handwashing (OR 1.217, 95% CI 0.969-1.528). Women who use technology to access health information are also more likely to know the risks of open defecation (OR 1.627, 95% CI 1.170-2.264) and use a type of toilet (such as a gooseneck or squat toilet) that limits risk (OR 3.858, 95% CI 2.628-5.665) compared to women who did not use technology to access health information. Conclusions: Using technology to access health information and services was associated with an increase in handwashing and defecation knowledge. In the future, promoting mothers of children under 2 years of age to access health information through technology might be used to increase handwashing and defecation knowledge as well as safe defecation practices. However, further research should be done to determine how technology may increase the frequency of recommended handwashing behaviors. %M 33443485 %R 10.2196/19349 %U http://publichealth.jmir.org/2021/1/e19349/ %U https://doi.org/10.2196/19349 %U http://www.ncbi.nlm.nih.gov/pubmed/33443485 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24733 %T Perceived Needs Versus Predisposing/Enabling Characteristics in Relation to Internet Cancer Information Seeking Among the US and Chinese Public: Comparative Survey Research %A Zhang,Di %A Hu,Hongchao %A Shi,Zhen %A Li,Biao %+ School of Journalism and Communication, Renmin University of China, RM713 Mingde Journalism Buliding, Renmin University of China, 59 Zhongguancun Rd, Haidian Dist, Beijing, 100872, China, 86 18810286586, libiao@ruc.edu.cn %K HINTS %K health information seeking behavior (HISB) %K China %K United States %K comparative research %K cultural sensitivity %D 2021 %7 11.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the rise of the internet, online health information seeking has become a worldwide phenomenon. However, health and health communication are inherently culture bound. A data-driven cross-country comparison enables us to better understand how cultural factors moderate the association between individual-level determinants and online health information seeking. Objective: The objective of the study was to examine similarities and differences in determinants of internet cancer information seeking between the US and Chinese general public (excluding cancer patients and survivors) under the framework of a behavioral model of health services use. Methods: This study used Health Information National Trends Survey (HINTS) 2017 (US data) and HINTS-China 2017 data to answer the research question. It focused on people with no cancer history and with internet access. For the HINTS 2017, the sample size was 2153; for the HINTS-China 2017, the sample size was 2358. To compare China and the United States, the researchers selected the same set of study variables for each dataset. Under the framework of the behavioral model of health services use, these predictors were predisposing factors, enabling factors, and need factors. Results: In terms of the predisposing factors, a higher age, college degree or above, being currently unemployed, and having a family history of cancer were associated with internet cancer information seeking for the Chinese respondents; none of these factors were related to information seeking for the US respondents, although a lower age was associated with information seeking. Regarding the enabling conditions, lower trust in family members and friends as reliable information sources was the only factor associated with information seeking for the Chinese respondents, while no enabling factor was related to information seeking for the US respondents. Regarding the need factors, perceived health status was not related to information seeking for the Chinese respondents, while perception of poorer health condition was related to information seeking for the US respondents. Higher cancer fear was related to information seeking for both groups, but the magnitude of association was smaller for the Chinese respondents than for the US respondents. Conclusions: Overall, under the framework of the behavioral model of health services use, the results based on multivariate logistic regression reveal clear patterns of cross-country/cultural differences in the factors associated with internet cancer information seeking behaviors: predisposing characteristics and enabling conditions are more important in China, while perceived needs are more significant in the US. Such differences might reflect possible US-China differences in job environment (eg, job pressure) and culture (individualism vs collectivism and family structure). %M 33427668 %R 10.2196/24733 %U http://www.jmir.org/2021/1/e24733/ %U https://doi.org/10.2196/24733 %U http://www.ncbi.nlm.nih.gov/pubmed/33427668 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e24618 %T Development of Social Support Networks by Patients With Depression Through Online Health Communities: Social Network Analysis %A Lu,Yingjie %A Luo,Shuwen %A Liu,Xuan %+ School of Business, East China University of Science and Technology, Meilong Road 130, Shanghai, 200237, China, 86 2164252489, xuanliu@ecust.edu.cn %K online depression community %K social support network %K exponential random graph model %K informational support %K emotional support %K mental health %K depression %K social network %D 2021 %7 7.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: In recent years, people with mental health problems are increasingly using online social networks to receive social support. For example, in online depression communities, patients can share their experiences, exchange valuable information, and receive emotional support to help them cope with their disease. Therefore, it is critical to understand how patients with depression develop online social support networks to exchange informational and emotional support. Objective: Our aim in this study was to investigate which user attributes have significant effects on the formation of informational and emotional support networks in online depression communities and to further examine whether there is an association between the two social networks. Methods: We used social network theory and constructed exponential random graph models to help understand the informational and emotional support networks in online depression communities. A total of 74,986 original posts were retrieved from 1077 members in an online depression community in China from April 2003 to September 2017 and the available data were extracted. An informational support network of 1077 participant nodes and 6557 arcs and an emotional support network of 1077 participant nodes and 6430 arcs were constructed to examine the endogenous (purely structural) effects and exogenous (actor-relation) effects on each support network separately, as well as the cross-network effects between the two networks. Results: We found significant effects of two important structural features, reciprocity and transitivity, on the formation of both the informational support network (r=3.6247, P<.001, and r=1.6232, P<.001, respectively) and the emotional support network (r=4.4111, P<.001, and r=0.0177, P<.001, respectively). The results also showed significant effects of some individual factors on the formation of the two networks. No significant effects of homophily were found for gender (r=0.0783, P=.20, and r=0.1122, P=.25, respectively) in the informational or emotional support networks. There was no tendency for users who had great influence (r=0.3253, P=.05) or wrote more posts (r=0.3896, P=.07) or newcomers (r=–0.0452, P=.66) to form informational support ties more easily. However, users who spent more time online (r=0.6680, P<.001) or provided more replies to other posts (r=0.5026, P<.001) were more likely to form informational support ties. Users who had a big influence (r=0.8325, P<.001), spent more time online (r=0.5839, P<.001), wrote more posts (r=2.4025, P<.001), or provided more replies to other posts (r=0.2259, P<.001) were more likely to form emotional support ties, and newcomers (r=–0.4224, P<.001) were less likely than old-timers to receive emotional support. In addition, we found that there was a significant entrainment effect (r=0.7834, P<.001) and a nonsignificant exchange effect (r=–0.2757, P=.32) between the two networks. Conclusions: This study makes several important theoretical contributions to the research on online depression communities and has important practical implications for the managers of online depression communities and the users involved in these communities. %M 33279878 %R 10.2196/24618 %U http://medinform.jmir.org/2021/1/e24618/ %U https://doi.org/10.2196/24618 %U http://www.ncbi.nlm.nih.gov/pubmed/33279878 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e18816 %T The Online Health Information Needs of Family Physicians: Systematic Review of Qualitative and Quantitative Studies %A van der Keylen,Piet %A Tomandl,Johanna %A Wollmann,Katharina %A Möhler,Ralph %A Sofroniou,Mario %A Maun,Andy %A Voigt-Radloff,Sebastian %A Frank,Luca %+ Friedrich-Alexander University Erlangen-Nürnberg, Institute of General Practice, University Hospital Erlangen, Universitätsstr 29, Erlangen, 91054, Germany, 49 91318544953, Piet.Keylen@uk-erlangen.de %K family physicians %K general practitioners %K primary care %K needs %K barriers %K online information %K health information %K health resources %K internet %K information-seeking behaviors %K mobile phone %D 2020 %7 30.12.2020 %9 Review %J J Med Internet Res %G English %X Background: Digitalization and the increasing availability of online information have changed the way in which information is searched for and retrieved by the public and by health professionals. The technical developments in the last two decades have transformed the methods of information retrieval. Although systematic evidence exists on the general information needs of specialists, and in particular, family physicians (FPs), there have been no recent systematic reviews to specifically address the needs of FPs and any barriers that may exist to accessing online health information. Objective: This review aims to provide an up-to-date perspective on the needs of FPs in searching, retrieving, and using online information. Methods: This systematic review of qualitative and quantitative studies searched a multitude of databases spanning the years 2000 to 2020 (search date January 2020). Studies that analyzed the online information needs of FPs, any barriers to the accessibility of information, and their information-seeking behaviors were included. Two researchers independently scrutinized titles and abstracts, analyzing full-text papers for their eligibility, the studies therein, and the data obtained from them. Results: The initial search yielded 4541 studies for initial title and abstract screening. Of the 144 studies that were found to be eligible for full-text screening, 41 were finally included. A total of 20 themes were developed and summarized into 5 main categories: individual needs of FPs before the search; access needs, including factors that would facilitate or hinder information retrieval; quality needs of the information to hand; utilization needs of the information available; and implication needs for everyday practice. Conclusions: This review suggests that searching, accessing, and using online information, as well as any pre-existing needs, barriers, or demands, should not be perceived as separate entities but rather be regarded as a sequential process. Apart from accessing information and evaluating its quality, FPs expressed concerns regarding the applicability of this information to their everyday practice and its subsequent relevance to patient care. Future online information resources should cater to the needs of the primary care setting and seek to address the way in which such resources may be adapted to these specific requirements. %M 33377874 %R 10.2196/18816 %U http://www.jmir.org/2020/12/e18816/ %U https://doi.org/10.2196/18816 %U http://www.ncbi.nlm.nih.gov/pubmed/33377874 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 12 %P e19061 %T Predictors of Internet Use Among Older Adults With Diabetes in South Korea: Survey Study %A Park,Sunhee %A Kim,Beomsoo %+ Barun ICT Research Center, Yonsei University, Yonsei-samsung Bldg, 7th Floor, 50 Yonsei-ro, Seodamun-gu, Seoul, 03722, Republic of Korea, 82 2 2123 6694, sunny372@hanmail.net %K digital divide %K internet use %K older adults %K diabetes %K health %K internet %K Korea %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Internet access in Korea has grown dramatically over the past two decades. However, disparities in internet use, referred to as the second level of the digital divide, persist. Objective: This study aims to examine opportunity, motivation, and health variables that indicate internet use among older adults with diabetes. Methods: Data were sourced from a nationally representative sample of people 65 years and older with diabetes (N=1919). Logistic regression was used to explore potential differences in predictor variables between internet users and nonusers. Results: Only 306 of the 1919 (15.95%) participants in the sample used the internet. They were more likely to be younger (odds ratio [OR] 0.89, 95% CI 0.87-0.92), well-educated (OR 1.20, 95% CI 1.16-1.26), and able to afford leisure expenditures (OR 1.02, 95% CI 1.01-1.04). Additionally, they had more information and communications technology (ICT) training experience, were motivated to learn, volunteered, and reported good physical and cognitive function. Participation in ICT education and better health more positively correlated with a higher rate of internet use than did years of education or economic standing in older adults with diabetes. Conclusions: To support older adults with diabetes in the internet age, policies and health care providers should focus on digital competency training as well as physical and cognitive function. %M 33277232 %R 10.2196/19061 %U http://medinform.jmir.org/2020/12/e19061/ %U https://doi.org/10.2196/19061 %U http://www.ncbi.nlm.nih.gov/pubmed/33277232 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23518 %T COVID-19 Symptom-Related Google Searches and Local COVID-19 Incidence in Spain: Correlational Study %A Jimenez,Alberto Jimenez %A Estevez-Reboredo,Rosa M %A Santed,Miguel A %A Ramos,Victoria %+ Faculty of Psychology, Universidad Nacional de Educación a Distancia, Calle de Juan del Rosal 10, Madrid, 28040, Spain, 34 646517577, msanted@psi.uned.es %K behavioral epidemiology %K big data %K smart data %K tracking %K nowcasting %K forecast %K predict %K infosurveillance %K infodemiology %K COVID-19 %D 2020 %7 18.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is one of the biggest pandemics in human history, along with other disease pandemics, such as the H1N1 influenza A, bubonic plague, and smallpox pandemics. This study is a small contribution that tries to find contrasted formulas to alleviate global suffering and guarantee a more manageable future. Objective: In this study, a statistical approach was proposed to study the correlation between the incidence of COVID-19 in Spain and search data provided by Google Trends. Methods: We assessed the linear correlation between Google Trends search data and the data provided by the National Center of Epidemiology in Spain—which is dependent on the Instituto de Salud Carlos III—regarding the number of COVID-19 cases reported with a certain time lag. These data enabled the identification of anticipatory patterns. Results: In response to the ongoing outbreak, our results demonstrate that by using our correlation test, the evolution of the COVID-19 pandemic can be predicted in Spain up to 11 days in advance. Conclusions: During the epidemic, Google Trends offers the possibility to preempt health care decisions in real time by tracking people's concerns through their search patterns. This can be of great help given the critical, if not dramatic need for complementary monitoring approaches that work on a population level and inform public health decisions in real time. This study of Google search patterns, which was motivated by the fears of individuals in the face of a pandemic, can be useful in anticipating the development of the pandemic. %M 33156803 %R 10.2196/23518 %U http://www.jmir.org/2020/12/e23518/ %U https://doi.org/10.2196/23518 %U http://www.ncbi.nlm.nih.gov/pubmed/33156803 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e19747 %T Physiotherapists’ Use of Web-Based Information Resources to Fulfill Their Information Needs During a Theoretical Examination: Randomized Crossover Trial %A Doherty,Cailbhe %A Joorabchi,Arash %A Megyesi,Peter %A Flynn,Aileen %A Caulfield,Brian %+ School of Public Health, Physiotherapy and Sports Science, University College Dublin, A308, Health Science Building, Belfield, Dublin, D4, Ireland, 353 17166511, cailbhe.doherty@ucd.ie %K evidence-based medicine %K knowledge discovery %K information seeking behavior %K information dissemination %K information literacy %K online systems %K point-of-care systems %K mobile phone %D 2020 %7 17.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The widespread availability of internet-connected smart devices in the health care setting has the potential to improve the delivery of research evidence to the care pathway and fulfill health care professionals’ information needs. Objective: This study aims to evaluate the frequency with which physiotherapists experience information needs, the capacity of digital information resources to fulfill these needs, and the specific types of resources they use to do so. Methods: A total of 38 participants (all practicing physiotherapists; 19 females, 19 males) were randomly assigned to complete three 20-question multiple-choice questionnaire (MCQ) examinations under 3 conditions in a randomized crossover study design: assisted by a web browser, assisted by a federated search portal system, and unassisted. MCQ scores, times, and frequencies of information needs were recorded for overall examination-level and individual question-level analyses. Generalized estimating equations were used to assess differences between conditions for the primary outcomes. A log file analysis was conducted to evaluate participants’ web search and retrieval behaviors. Results: Participants experienced an information need in 55.59% (845/1520) MCQs (assisted conditions only) and exhibited a mean improvement of 10% and 16% in overall examination scores for the federated search and web browser conditions, respectively, compared with the unassisted condition (P<.001). In the web browser condition, Google was the most popular resource and the only search engine used, accounting for 1273 (64%) of hits, followed by PubMed (195 hits; 10% of total). In the federated search condition, Wikipedia and PubMed were the most popular resources with 1518 (46% of total) and 1273 (39% of total) hits, respectively. Conclusions: In agreement with the findings of previous research studies among medical physicians, the results of this study demonstrate that physiotherapists frequently experience information needs. This study provides new insights into the preferred digital information resources used by physiotherapists to fulfill these needs. Future research should clarify the implications of physiotherapists’ apparent high reliance on Google, whether these results reflect the authentic clinical environment, and whether fulfilling clinical information needs alters practice behaviors or improves patient outcomes. %M 33331826 %R 10.2196/19747 %U http://www.jmir.org/2020/12/e19747/ %U https://doi.org/10.2196/19747 %U http://www.ncbi.nlm.nih.gov/pubmed/33331826 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e25501 %T Impact of Telemedicine Use by Oncology Physicians on the Patient and Informal Caregiver Experience of Receiving Care: Protocol for a Scoping Review in the Context of COVID-19 %A Thiessen,Maclean %A Soriano,Andrea Michelle %A Loewen,Hal John %A Decker,Kathleen Margaret %+ Research Institute of Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada, 1 204 787 4249, macthiessen@gmail.com %K cancer %K experience %K information needs %K telemedicine %K telehealth %K COVID-19 %K patient satisfaction %D 2020 %7 15.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the COVID-19 pandemic, the use of telemedicine by oncology physicians in Manitoba, Canada, has increased to limit the risk of exposure to the virus for both patients and health care providers. It is not clear how telemedicine impacts the information needs of patients or the experience of receiving cancer care. Objective: The objective of this study is to describe how the use of telemedicine impacts the information needs and experience of patients with cancer and their informal caregivers (ie, family and friends) and identify directions for future research. Methods: This review will include all studies addressing telemedicine in the cancer context including those using quantitative, qualitative, and mixed methods approaches. This scoping review will be conducted using the methodology described by the Joanna Briggs Institute. In collaboration with a librarian scientist specializing in health sciences, a comprehensive search will be undertaken to identify and retrieve relevant reports published in English from 1990 to the present. Databases searched will include MEDLINE, CINAHL, EMBASE, Scopus, Cochrane Library, and PsycINFO. Data will be extracted by two independent reviewers, synthesized, and reported in a summary table and in a narrative format describing what has been reported regarding the impact of telemedicine by physicians in oncology on the experience of patients and their informal caregivers and their receipt of information. Results: The results from this scoping review are expected to be available by late spring 2021. Conclusions: The results from this scoping review will be useful for informing practice as well as directing future research, both in the context of COVID-19 and beyond. International Registered Report Identifier (IRRID): PRR1-10.2196/25501 %M 33290243 %R 10.2196/25501 %U http://www.researchprotocols.org/2020/12/e25501/ %U https://doi.org/10.2196/25501 %U http://www.ncbi.nlm.nih.gov/pubmed/33290243 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e18767 %T Using Social Media Data to Understand Consumers' Information Needs and Emotions Regarding Cancer: Ontology-Based Data Analysis Study %A Lee,Jooyun %A Park,Hyeoun-Ae %A Park,Seul Ki %A Song,Tae-Min %+ College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 740 8827, hapark@snu.ac.kr %K social media %K ontology %K cancer %K health information needs %K cancer information %K emotion %D 2020 %7 7.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Analysis of posts on social media is effective in investigating health information needs for disease management and identifying people’s emotional status related to disease. An ontology is needed for semantic analysis of social media data. Objective: This study was performed to develop a cancer ontology with terminology containing consumer terms and to analyze social media data to identify health information needs and emotions related to cancer. Methods: A cancer ontology was developed using social media data, collected with a crawler, from online communities and blogs between January 1, 2014 and June 30, 2017 in South Korea. The relative frequencies of posts containing ontology concepts were counted and compared by cancer type. Results: The ontology had 9 superclasses, 213 class concepts, and 4061 synonyms. Ontology-driven natural language processing was performed on the text from 754,744 cancer-related posts. Colon, breast, stomach, cervical, lung, liver, pancreatic, and prostate cancer; brain tumors; and leukemia appeared most in these posts. At the superclass level, risk factor was the most frequent, followed by emotions, symptoms, treatments, and dealing with cancer. Conclusions: Information needs and emotions differed according to cancer type. The observations of this study could be used to provide tailored information to consumers according to cancer type and care process. Attention should be paid to provision of cancer-related information to not only patients but also their families and the general public seeking information on cancer. %M 33284127 %R 10.2196/18767 %U http://www.jmir.org/2020/12/e18767/ %U https://doi.org/10.2196/18767 %U http://www.ncbi.nlm.nih.gov/pubmed/33284127 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 12 %P e23854 %T The Correlation of Online Health Information–Seeking Experience With Health-Related Quality of Life: Cross-Sectional Study Among Non–English-Speaking Female Students in a Religious Community %A Kavosi,Zahra %A Vahedian,Sara %A Montazeralfaraj,Razieh %A Dehghani Tafti,Arefeh %A Bahrami,Mohammad Amin %+ Health Human Resources Research Center, Department of Health Services Management, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Almas Building, Alley No. 29, Ghasr e Dasht St., Shiraz, 7175644654646, Iran, 98 9132565057, aminbahrami1359@gmail.com %K general health %K SF-36 %K information seeking behavior %K online health information %K high school students %K health literacy %D 2020 %7 2.12.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Given the increasing availability of the internet, it has become a common source of health information. However, the effect of this increased access on health needs to be further studied. Objective: This study aimed to investigate the correlation between online health information–seeking behavior and general health dimensions in a sample of high school students in Iran. Methods: A cross-sectional study was conducted in 2019. A total of 295 female students participated in the study. The data were collected using two validated questionnaires: the e-Health Impact Questionnaire and the 36-Item Short Form Health Survey. The collected data were analyzed through descriptive statistics and Pearson correlation coefficients using SPSS version 23 (IBM Corp). Results: The participants moderately used online information in their health-related decisions, and they thought that the internet helped people in health-related decision making. They also thought that the internet could be used to share health experiences with others. Participants had moderate confidence in online health information and stated that the information provided by health websites was moderately understandable and reliable and moderately encouraged and motivated them to play an active role in their health promotion. Nevertheless, the results showed that online health information–seeking experience had no significant correlation with health-related quality of life. Conclusions: This study provides insights into the effect of using internet information on the health of adolescents. It has important implications for researchers and policy makers to build appropriate policies to maximize the benefit of internet access for health. %M 33263546 %R 10.2196/23854 %U https://medinform.jmir.org/2020/12/e23854 %U https://doi.org/10.2196/23854 %U http://www.ncbi.nlm.nih.gov/pubmed/33263546 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e17771 %T Information Needs About Cancer Treatment, Fertility, and Pregnancy: Qualitative Descriptive Study of Reddit Threads %A Garg,Ria %A Rebić,Nevena %A De Vera,Mary A %+ Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, Canada, 1 604 207 040, mdevera@mail.ubc.ca %K cancer treatment %K health information %K oncofertility %K fertility %K pregnancy %K reproduction %K social support %D 2020 %7 2.12.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: A reproductive health implication of the increasing incidence of cancer among women is the impact of cancer treatment on fertility. Objective: As patients are increasingly using the internet, particularly online forums, to seek and share experiences, our objective was to understand information needs about cancer treatment, fertility, and pregnancy of women with cancer as well as their caregivers. Methods: We searched threads (original posts and responses) on four subreddit sites of Reddit (“r/Cancer,” “r/TryingForABaby,” “r/BabyBumps,” and “r/Infertility”) over a 5‐year period between February 4th, 2014 and February 4th, 2019. Threads with original posts involving a lived experience or question regarding cancer treatment and female fertility and/or pregnancy or parenting/having children from the perspective of either patient or caregiver were included in our analysis. We analyzed threads using thematic analysis. Results: From 963 Reddit threads identified, 69 were analyzed, including 56 with original posts by women with cancer and 13 with original posts by caregivers. From threads made by patients, we identified themes on becoming a part of an online community, impacts of cancer treatment and fertility concerns on self and social relationships, making family planning decisions, and experiences with medical team. We also identified a theme on the impact of cancer treatment and fertility concerns on caregivers. Conclusions: Reddit provided a rich pool of data for analyzing the information needs of women facing cancer. Our findings demonstrate the far-reaching impacts of cancer treatment and fertility on physical, mental, and psychosocial health for both patients and their caregivers. %M 33263547 %R 10.2196/17771 %U http://cancer.jmir.org/2020/2/e17771/ %U https://doi.org/10.2196/17771 %U http://www.ncbi.nlm.nih.gov/pubmed/33263547 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22407 %T COVID-19–Related Internet Search Patterns Among People in the United States: Exploratory Analysis %A Shen,Tony S %A Chen,Aaron Z %A Bovonratwet,Patawut %A Shen,Carol L %A Su,Edwin P %+ Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, United States, 1 8605196413, azc2001@med.cornell.edu %K COVID-19 %K pandemic %K internet %K infodemic %K infodemiology %K infoveillance %K natural language processing %K NLP %K health information %K information seeking %D 2020 %7 23.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet is a well-known source of information that patients use to better inform their opinions and to guide their conversations with physicians during clinic visits. The novelty of the recent COVID-19 outbreak has led patients to turn more frequently to the internet to gather more information and to alleviate their concerns about the virus. Objective: The aims of the study were to (1) determine the most commonly searched phrases related to COVID-19 in the United States and (2) identify the sources of information for these web searches. Methods: Search terms related to COVID-19 were entered into Google. Questions and websites from Google web search were extracted to a database using customized software. Each question was categorized into one of 6 topics: clinical signs and symptoms, treatment, transmission, cleaning methods, activity modification, and policy. Additionally, the websites were categorized according to source: World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), non-CDC government, academic, news, and other media. Results: In total, 200 questions and websites were extracted. The most common question topic was transmission (n=63, 31.5%), followed by clinical signs and symptoms (n=54, 27.0%) and activity modification (n=31, 15.5%). Notably, the clinical signs and symptoms category captured questions about myths associated with the disease, such as whether consuming alcohol stops the coronavirus. The most common websites provided were maintained by the CDC, the WHO, and academic medical organizations. Collectively, these three sources accounted for 84.0% (n=168) of the websites in our sample. Conclusions: In the United States, the most commonly searched topics related to COVID-19 were transmission, clinical signs and symptoms, and activity modification. Reassuringly, a sizable majority of internet sources provided were from major health organizations or from academic medical institutions. %M 33147163 %R 10.2196/22407 %U http://www.jmir.org/2020/11/e22407/ %U https://doi.org/10.2196/22407 %U http://www.ncbi.nlm.nih.gov/pubmed/33147163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23922 %T Relationship Between COVID-19 Information Sources and Attitudes in Battling the Pandemic Among the Malaysian Public: Cross-Sectional Survey Study %A Mohamad,Emma %A Tham,Jen Sern %A Ayub,Suffian Hadi %A Hamzah,Mohammad Rezal %A Hashim,Hasrul %A Azlan,Arina Anis %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600 UKM, Bangi, Selangor, 43600, Malaysia, 60 389215456, arina@ukm.edu.my %K COVID-19 %K information source %K confidence %K media %K social media %K government %K Malaysia %K online information %K survey %D 2020 %7 12.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There are multiple media platforms and various resources available for information on COVID-19. Identifying people’s preferences is key to building public confidence and planning for successful national health intervention strategies. Objective: This study examines the sources of information for COVID-19 used by the Malaysian public and identifies those that are associated with building public confidence and positive perceptions toward the Malaysian government. Methods: A cross-sectional online survey of 4850 Malaysian residents was conducted. Participant demographics, media use, information sources, and attitudes surrounding COVID-19 were assessed. Descriptive statistics and multiple logistic regression analyses were conducted to gauge the relationship between demographics, information sources, and attitudes toward COVID-19. Results: Malaysians primarily used television and internet news portals to access information on COVID-19. The Malaysian Ministry of Health was the most preferred source of COVID-19 information. Respondents who referred to the Ministry of Health, television, and the Malaysian National Security Council for information were more likely to believe that the country could win the battle against COVID-19 and that the government was handling the health crisis well compared to those who referred to other information sources. Those who used the World Health Organization, friends, YouTube, family, and radio as sources of information were less likely to harbor confidence and positive belief toward combating COVID-19. Conclusions: Managing information and sustaining public confidence is important during a pandemic. Health authorities should pay considerable attention to the use of appropriate media channels and sources to allow for more effective dissemination of critical information to the public. %M 33151897 %R 10.2196/23922 %U http://www.jmir.org/2020/11/e23922/ %U https://doi.org/10.2196/23922 %U http://www.ncbi.nlm.nih.gov/pubmed/33151897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22910 %T Online Health Information Seeking Using “#COVID-19 Patient Seeking Help” on Weibo in Wuhan, China: Descriptive Study %A Zhao,Xiaoman %A Fan,Ju %A Basnyat,Iccha %A Hu,Baijing %+ School of Journalism and Communication, Renmin University of China, 59 Zhongguancun Street, Beijing, China, 86 01062514835, hubaijing@vip.sina.com %K COVID-19 %K coronavirus %K information seeking %K social media %K Wuhan %D 2020 %7 15.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: First detected in Wuhan, China in December 2019, the COVID-19 pandemic stretched the medical system in Wuhan and posed a challenge to the state’s risk communication efforts. Timely access to quality health care information during outbreaks of infectious diseases can be effective to curtail the spread of disease and feelings of anxiety. Although existing studies have extended our knowledge about online health information–seeking behavior, processes, and motivations, rarely have the findings been applied to an outbreak. Moreover, there is relatively little recent research on how people in China are using the internet for seeking health information during a pandemic. Objective: The aim of this study is to explore how people in China are using the internet for seeking health information during a pandemic. Drawing on previous research of online health information seeking, this study asks the following research questions: how was the “#COVID-19 Patient Seeking Help” hashtag being used by patients in Wuhan seeking health information on Weibo at the peak of the outbreak? and what kinds of health information were patients in Wuhan seeking on Weibo at the peak of the outbreak? Methods: Using entity identification and textual analysis on 10,908 posts on Weibo, we identified 1496 patients with COVID-19 using “#COVID-19 Patient Seeking Help” and explored their online health information–seeking behavior. Results: The curve of the hashtag posting provided a dynamic picture of public attention to the COVID-19 pandemic. Many patients faced difficulties accessing offline health care services. In general, our findings confirmed that the internet is used by the Chinese public as an important source of health information. The lockdown policy was found to cut off the patients’ social support network, preventing them from seeking help from family members. The ability to seek information and help online, especially for those with young children or older adult members during the pandemic. A high proportion of female users were seeking health information and help for their parents or for older adults at home. The most searched information included accessing medical treatment, managing self-quarantine, and offline to online support. Conclusions: Overall, the findings contribute to our understanding of health information–seeking behaviors during an outbreak and highlight the importance of paying attention to the information needs of vulnerable groups and the role social media may play. %M 33001838 %R 10.2196/22910 %U http://www.jmir.org/2020/10/e22910/ %U https://doi.org/10.2196/22910 %U http://www.ncbi.nlm.nih.gov/pubmed/33001838 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22596 %T Associations of Mental Health and Personal Preventive Measure Compliance With Exposure to COVID-19 Information During Work Resumption Following the COVID-19 Outbreak in China: Cross-Sectional Survey Study %A Pan,Yihang %A Xin,Meiqi %A Zhang,Changhua %A Dong,Willa %A Fang,Yuan %A Wu,Wenhui %A Li,Mingzhe %A Pang,Jun %A Zheng,Zilong %A Wang,Zixin %A Yuan,Jinqiu %A He,Yulong %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, 666888, Hong Kong, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K information exposure %K risk %K communication %K mental health %K personal preventive measures %K China %K cross-sectional %K public health %K prevention %D 2020 %7 8.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Risk and crisis communication plays an essential role in public health emergency responses. The COVID-19 pandemic has triggered spontaneous and intensive media attention, which has affected people’s adoption of personal preventive measures and their mental health. Objective: The aim of this study was to investigate the associations between exposure to COVID-19–specific information and mental health (depression and sleep quality) and self-reported compliance with personal preventive measures (face mask wearing and hand sanitizing). We also tested whether these associations were moderated by thoughtful consideration of the veracity of the information to which people were exposed. Methods: A cross-sectional, closed web-based survey was conducted among a sample of 3035 factory workers at the beginning of work resumption following the COVID-19 outbreak in Shenzhen, China. A stratified two-stage cluster sampling design was used for recruitment. Multivariate linear and logistic regression models were used for the analyses. Results: The prevalence of probable moderate-to-severe depression was 170/3035 (5.6%), while that of good or excellent sleep quality was 2110/3035 (69.5%). The prevalence of self-reported consistent face mask wearing in public places was 2903/3035 (95.7%), while that of sanitizing hands every time after returning from public spaces or touching public installations was 2151/3035 (70.9%). Of the 3035 respondents, 1013 to 1638 (33.3% to 54.0%) reported >1 hour of daily exposure to COVID-19–specific information through web-based media and television. After controlling for significant background variables, higher information exposure via television and via newspapers and magazines was associated with better sleep quality and higher compliance with hand sanitizing. Higher exposure via unofficial web-based media was associated with higher compliance with hand sanitizing but was also associated with higher depressive symptoms. In contrast, higher exposure through face-to-face communication was associated with higher depressive symptoms, worse sleep quality, and lower compliance with hand sanitizing. Exposure to information about positive outcomes for patients with COVID-19, development of vaccines and effective treatments, and heroic stories about frontline health care workers were associated with both better mental health and higher compliance with preventive measures. Higher overall information exposure was associated with higher depressive symptoms among participants who were less likely to carefully consider the veracity of the information to which they were exposed; it was also associated with better sleep quality among people who reported more thoughtful consideration of information veracity. Conclusions: This study provides empirical evidence of how the amount, sources, and contents of information to which people were exposed influenced their mental health and compliance with personal preventive measures at the initial phase of work resumption in China. Thoughtful consideration of information quality was found to play an important moderating role. Our findings may inform strategic risk communication by government and public health authorities during the COVID-19 pandemic. %M 32936776 %R 10.2196/22596 %U http://www.jmir.org/2020/10/e22596/ %U https://doi.org/10.2196/22596 %U http://www.ncbi.nlm.nih.gov/pubmed/32936776 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e21071 %T Trends and Predictors of COVID-19 Information Sources and Their Relationship With Knowledge and Beliefs Related to the Pandemic: Nationwide Cross-Sectional Study %A Ali,Shahmir H %A Foreman,Joshua %A Tozan,Yesim %A Capasso,Ariadna %A Jones,Abbey M %A DiClemente,Ralph J %+ Department of Social & Behavioral Sciences, School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, United States, 1 (212) 992 3709, rjd438@nyu.edu %K COVID-19 %K coronavirus %K pandemic %K outbreak %K infectious disease %K social media %K information seeking behaviors %K surveillance %D 2020 %7 8.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, there is a heightened need to understand health information seeking behaviors to address disparities in knowledge and beliefs about the crisis. Objective: This study assessed sociodemographic predictors of the use and trust of different COVID-19 information sources, as well as the association between information sources and knowledge and beliefs about the pandemic. Methods: An online survey was conducted among US adults in two rounds during March and April 2020 using advertisement-based recruitment on social media. Participants were asked about their use of 11 different COVID-19 information sources as well as their most trusted source of information. The selection of COVID-related knowledge and belief questions was based on past empirical literature and salient concerns at the time of survey implementation. Results: The sample consisted of 11,242 participants. When combined, traditional media sources (television, radio, podcasts, or newspapers) were the largest sources of COVID-19 information (91.2%). Among those using mainstream media sources for COVID-19 information (n=7811, 69.5%), popular outlets included CNN (24.0%), Fox News (19.3%), and other local or national networks (35.2%). The largest individual information source was government websites (87.6%). They were also the most trusted source of information (43.3%), although the odds of trusting government websites were lower among males (adjusted odds ratio [AOR] 0.58, 95% CI 0.53-0.63) and those aged 40-59 years and ≥60 years compared to those aged 18-39 years (AOR 0.83, 95% CI 0.74-0.92; AOR 0.62, 95% CI 0.54-0.71). Participants used an average of 6.1 sources (SD 2.3). Participants who were male, aged 40-59 years or ≥60 years; not working, unemployed, or retired; or Republican were likely to use fewer sources while those with children and higher educational attainment were likely to use more sources. Participants surveyed in April were markedly less likely to use (AOR 0.41, 95% CI 0.35-0.46) and trust (AOR 0.51, 95% CI 0.47-0.56) government sources. The association between information source and COVID-19 knowledge was mixed, while many COVID-19 beliefs were significantly predicted by information source; similar trends were observed with reliance on different types of mainstream media outlets. Conclusions: COVID-19 information source was significantly determined by participant sociodemographic characteristics and was also associated with both knowledge and beliefs about the pandemic. Study findings can help inform COVID-19 health communication campaigns and highlight the impact of using a variety of different and trusted information sources. %M 32936775 %R 10.2196/21071 %U http://publichealth.jmir.org/2020/4/e21071/ %U https://doi.org/10.2196/21071 %U http://www.ncbi.nlm.nih.gov/pubmed/32936775 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e15352 %T Online Health Resource Use by Individuals With Inflammatory Bowel Disease: Analysis Using the National Health Interview Survey %A Yin,Rong %A Neyens,David M %+ Department of Industrial Engineering, Clemson University, 100 Freeman Hall, Clemson, SC, 29634, United States, 1 8646564719, dneyens@clemson.edu %K internet %K searching behavior %K access to information %K inflammatory bowel disease %K logistic regression model %K National Health Interview Survey %D 2020 %7 24.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet has enabled convenient and efficient health information searching which is valuable for individuals with chronic conditions requiring some level of self-management. However, there is little research evaluating what factors may impact the use of the internet for health-related tasks for specific clinical populations, such as individuals with inflammatory bowel diseases. Objective: Our goal was to investigate the factors that influence internet use in acquiring health information by individuals with inflammatory bowel diseases. Specifically, we identified factors associated with internet searching behavior and using the internet for completing health-related tasks. Methods: We used 2016 National Health Interview Survey weighted data to develop logistic regression models to predict the likelihood that individuals with inflammatory bowel diseases would use the internet for 2 types of tasks: seeking health information through online searches and using the internet to perform health-related tasks including scheduling appointments and emailing care providers. Results: 2016 National Health Interview Survey weighted data include more than 3 million weighted adult respondents with inflammatory bowel diseases (approximately 1.29% of adults in the weighted data set). Our results suggest that approximately 66.3% of those with inflammatory bowel diseases reported using the internet at least once a day, and approximately 14.7% reported being dissatisfied with their current health care. About 62.3% of those with inflammatory bowel diseases reported that they had looked up health information online, 16.3% of those with inflammatory bowel diseases reported that they had scheduled an appointment with a health care provider online, and 21.6% reported having used a computer to communicate with a health provider by email. We found that women who were self-regulating their care were more likely to look up health information online than others. Both middle-aged and older adults with inflammatory bowel diseases who were unsatisfied with their current health care were less likely to look up health information online. Frequent internet users who were worried about medical costs were more likely to look up health information online. Similarly, the results from our statistical models suggest that individuals with inflammatory bowel diseases who were frequent internet users were more likely to use the internet for specific health-related tasks. Additionally, women with inflammatory bowel diseases who reported being married were less likely to use the internet for specific health-related tasks. Conclusions: For those with inflammatory bowel diseases, there are additional socioeconomic and behavioral factors that impact the use of the internet for health information and health-related tasks. Future research should evaluate how these factors moderate the use of the internet and identify how online resources can support clinical populations in ways that improve access to information, support health self-management, and subsequently improve health outcomes. %M 32969831 %R 10.2196/15352 %U http://www.jmir.org/2020/9/e15352/ %U https://doi.org/10.2196/15352 %U http://www.ncbi.nlm.nih.gov/pubmed/32969831 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20910 %T Exploring Types of Information Sources Used When Choosing Doctors: Observational Study in an Online Health Care Community %A Zhang,Shuang %A Wang,Jying-Nan %A Chiu,Ya-Ling %A Hsu,Yuan-Teng %+ Research Center of Finance, Shanghai Business School, No 2271 West Zhong Shan Rd, Shanghai, 200235, China, 86 21 64870020 ext 1404, yuanteng.hsu@gmail.com %K information source %K decision making %K online reviews %K online health care community %K doctor %K health information %D 2020 %7 16.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients attempt to make appropriate decisions based on their own knowledge when choosing a doctor. In this process, the first question usually faced is that of how to obtain useful and relevant information. This study investigated the types of information sources that are used widely by patients in choosing a doctor and identified ways in which the preferred sources differ in various situations. Objective: This study aims to address the following questions: (1) What is the proportion in which each of the various information sources is used? (2) How does the information source preferred by patients in choosing a doctor change when there is a difference in the difficulty of medical decision making, in the level of the hospital, or in a rural versus urban situation? (3) How do information sources used by patients differ when they choose doctors with different specialties? Methods: This study overcomes a major limitation in the use of the survey technique by employing data from the Good Doctor website, which is now China's leading online health care community, data which are objective and can be obtained relatively easily and frequently. Multinomial logistic regression models were applied to examine whether the proportion of use of these information sources changes in different situations. We then used visual analysis to explore the question of which type of information source patients prefer to use when they seek medical assistance from doctors with different specialties. Results: The 3 main information sources were online reviews (OR), family and friend recommendations (FR), and doctor recommendations (DR), with proportions of use of 32.93% (559,345/1,698,666), 23.68% (402,322/1,698,666), and 17.48% (296,912/1,698,666), respectively. Difficulty in medical decision making, the hospital level, and rural-urban differences were significantly associated with patients’ preferred information sources for choosing doctors. Further, the sources of information that patients prefer to use were found to vary when they looked for doctors with different medical specialties. Conclusions: Patients are less likely to use online reviews when medical decisions are more difficult or when the provider is not a tertiary hospital, the former situation leading to a greater use of online reviews and the latter to a greater use of family and friend recommendations. In addition, patients in large cities are more likely to use information from online reviews than family and friend recommendations. Among different medical specialties, for those in which personal privacy is a concern, online reviews are the most common source. For those related to children, patients are more likely to refer to family and friend recommendations, and for those related to surgery, they value doctor recommendations more highly. Our results can not only contribute to aiding government efforts to further promote the dissemination of health care information but may also help health care industry managers develop better marketing strategies. %M 32936080 %R 10.2196/20910 %U http://www.jmir.org/2020/9/e20910/ %U https://doi.org/10.2196/20910 %U http://www.ncbi.nlm.nih.gov/pubmed/32936080 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20632 %T Real-World Evidence on the Effect of Missing an Oral Contraceptive Dose: Analysis of Internet Search Engine Queries %A Hochberg,Irit %A Orshalimy,Sharon %A Yom-Tov,Elad %+ Microsoft Research, 13 Shenkar st, Herzeliya, 46733, Israel, 972 747111359, eladyt@microsoft.com %K search engines %K birth control %K abortion %K miscarriage %D 2020 %7 15.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Oral contraceptives (OCs) are a unique chronic medication with which a memory slip may result in a threat that could change a person’s life course. Subjective concerns of missed OC doses among women have been addressed infrequently. Anonymized queries to internet search engines provide unique access to concerns and information gaps faced by a large number of internet users. Objective: We aimed to quantitate the frequency of queries by women seeking information in an internet search engine, after missing one or more doses of an OC; their further queries on emergency contraception, abortion, and miscarriage; and their rate of reporting a pregnancy timed to the cycle of missing an OC. Methods: We extracted all English-language queries submitted to Bing in the United States during 2018, which mentioned a missed OC and subsequent queries of the same users on miscarriage, abortion, emergency contraceptives, and week of pregnancy. Results: We identified 26,395 Bing users in the United States who queried about missing OC pills and the fraction that further queried about miscarriage, abortion, emergency contraceptive, and week of pregnancy. Users under the age of 30 years who asked about forgetting an OC dose were more likely to ask about abortion (1.5 times) and emergency contraception (1.7 times) (P<.001 for both), while users at ages of 30-34 years were more likely to query about pregnancy (2.1 times) and miscarriage (5.4 times) (P<.001 for both). Conclusions: Our data indicate that many women missing a dose of OC might not have received sufficient information from their health care providers or chose to obtain it online. Queries about abortion and miscarriage peaking in the subsequent days indicate a common worry of possible pregnancy. These results reinforce the importance of providing comprehensive written information on missed pills when prescribing an OC. %M 32930672 %R 10.2196/20632 %U http://www.jmir.org/2020/9/e20632/ %U https://doi.org/10.2196/20632 %U http://www.ncbi.nlm.nih.gov/pubmed/32930672 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e18120 %T Integration of Conversion Factors for the Development of an Inclusive eHealth Tool With Caregivers of Functionally Dependent Older Persons: Social Justice Design %A Latulippe,Karine %A Hamel,Christine %A Giroux,Dominique %+ Laval University, 2325 Rue de l'Université, Québec, QC, , Canada, 1 418 435 8541, karine.latulippe.3@ulaval.ca %K caregivers %K aged %K help-seeking behavior %K community-based participatory research %K eHealth %K telemedicine %K mobile phone %D 2020 %7 26.8.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: eHealth can help reduce social health inequalities (SHIs); at the same time, it also has the potential to increase them. Several conversion factors can be integrated into the development of an eHealth tool to make it inclusive: (1) providing physical, technical, and financial access to eHealth; (2) enabling the integration of people at risk of SHIs into the research and development of digital projects targeting such populations (co-design or participatory research); (3) promoting consistency between the digital health literacy level of future users (FUs) and the eHealth tool; (4) developing an eHealth tool that is consistent with the technological skills of FUs; (5) ensuring that the eHealth tool is consistent with the help-seeking process of FUs; (6) respecting the learning capacities of FUs; and (7) being sensitive to FUs’ cultural context. However, only little empirical evidence pointing out how these conversion factors can be integrated into an effective eHealth tool is available. Objective: On the basis of Amartya Sen’s theoretical framework of social justice, the objective of this study was to explore how these 7 conversion factors can be integrated into an eHealth tool for caregivers of functionally dependent older persons. Methods: This study was based on a social justice design and participant observation as part of a large-scale research project funded by the Ministère de la Famille through the Quebec Ami des Aînés Program. Data were collected by recording the preparation sessions, the co-design and advisory committee sessions, as well as the debriefing sessions. The results were analyzed using Miles and Huberman’s method. Results: A total of 78 co-designers participated in 11 co-design sessions, 24 preparation sessions, and 11 debriefing sessions. Of the 7 conversion factors, 5 could be explored in this experiment. The integration of conversion factors has been uneven. The participation of FUs in the development of the tool supports other conversion factors. Respecting the eHealth literacy level of FUs means that their learning abilities and technological skills are also respected because they are closely related to one another and are therefore practically difficult to be distinguished. Conclusions: Conversion factors can be integrated into the development of eHealth tools that are intended to be inclusive and contribute to curbing SHIs by integrating FU participation into the tool design process. %M 32845242 %R 10.2196/18120 %U http://humanfactors.jmir.org/2020/3/e18120/ %U https://doi.org/10.2196/18120 %U http://www.ncbi.nlm.nih.gov/pubmed/32845242 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19985 %T Online Health Information Seeking by Parents for Their Children: Systematic Review and Agenda for Further Research %A Kubb,Christian %A Foran,Heather M %+ Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Universitätsstraße 65-67, Klagenfurt, 9020, Austria, 43 463 2700 1631, christian.kubb@aau.at %K information seeking behavior %K parents %K child %K internet %K health behavior %K digital health %D 2020 %7 25.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Parents commonly use the internet to search for information about their child’s health-related symptoms and guide parental health-related decisions. Despite the impact of parental online health seeking on offline health behaviors, this area of research remains understudied. Previous literature has not adequately distinguished searched behaviors when searching for oneself or one`s child. Objective: The purpose of this review is to examine prevalences and associated variables of parent-child online health information seeking; investigate parents’ health-related online behavior regarding how they find, use, and evaluate information; and identify barriers and concerns that they experience during the search. Based on this analysis, we develop a conceptual model of potentially important variables of proxy online health information seeking, with a focus on building an agenda for further research. Methods: We conducted a comprehensive systematic literature review of the PsycINFO, JMIR, and PubMed electronic databases. Studies between January 1994 and June 2018 were considered. The conceptual model was developed using an inductive mixed methods approach based on the investigated variables in the study sample. Results: A total of 33 studies met the inclusion criteria. Findings suggest that parents worldwide are heavy online users of health-related information for their children across highly diverse circumstances. A total of 6 studies found high parental health anxiety, with prevalences ranging from 14% to 52%. Although parents reported wishing for more guidance from their pediatrician on how to find reliable information, they rarely discussed retrieved information from the web. The conceptual model of proxy online health information seeking includes 49 variables. Conclusions: This systematic review identifies important gaps regarding the influence of health-related information on parents’ health behavior and outcomes. Follow-up studies are required to offer parents guidance on how to use the web for health purposes in an effective way, as well as solutions to the multifaceted problems during or after online health information seeking for their child. The conceptual model with the number of studies in each model category listed highlights how previous studies have hardly considered relational variables between the parent and child. An agenda for future research is presented. %M 32840484 %R 10.2196/19985 %U http://www.jmir.org/2020/8/e19985/ %U https://doi.org/10.2196/19985 %U http://www.ncbi.nlm.nih.gov/pubmed/32840484 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e20312 %T Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic %A Casilang,Clarisse G %A Stonbraker,Samantha %A Japa,Ingrid %A Halpern,Mina %A Messina,Luz %A Steenhoff,Andrew P %A Lowenthal,Elizabeth D %A Fleisher,Linda %+ Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, United States, 1 267 426 6298, casilangc@email.chop.edu %K global health %K breast feeding %K mHealth %K mobile phone %D 2020 %7 21.8.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide. Objective: This study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ≤5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs. Methods: Participants were recruited from 3 outpatient sites: the Niños Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes. Results: All participants (N=35) reported having a mobile phone, and 29 (83%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding. Conclusions: There is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding. %M 32821063 %R 10.2196/20312 %U http://pediatrics.jmir.org/2020/2/e20312/ %U https://doi.org/10.2196/20312 %U http://www.ncbi.nlm.nih.gov/pubmed/32821063 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e16138 %T Beliefs and Information Seeking in Patients With Cancer in Southwest China: Survey Study %A Xie,Juan %A Xie,Shi %A Cheng,Ying %A He,Zhe %+ School of Information Management, Nanjing University, 163 Xianlin Road, Nanjing, 210023, China, 86 13851838364, chengy@nju.edu.cn %K cancer information seeking %K cancer belief %K fatalism %K southwest China %D 2020 %7 21.8.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Although previous studies have reported the cancer information-seeking behaviors among patients in high-income countries, the cancer information-seeking practices of patients living in low- and middle-income areas are less known. Objective: This study investigated the beliefs and information-seeking patterns of cancer patients in southwest China. Methods: A questionnaire was designed, and data were collected in two hospitals (N=285) in southwest China. Statistical analyses included bivariate analyses and regressions. Results: Patients’ attitudes towards cancer fatalism were significantly influenced by marital status (P<.001), education (P<.001), and household income (P<.001). Moreover, endorsing fatalistic belief was positively associated with age (r=0.35, P<.001). The regression model showed that younger patients (odds ratio [OR] 0.96, 95% CI 0.93-0.99) and those with higher education (OR 1.75, 95% CI 1.09-2.81) were more likely to seek information. Additionally, patients who were less confident in getting information were more likely to find information (OR 1.70, 95% CI 1.15-2.52), while fatalism belief was not significant in the regression (OR 0.65, 95% CI 0.22-1.95). Conclusions: This study explored the information-seeking patterns of cancer patients in southwest China. It was found that many Chinese people endorsed cancer fatalism. These pessimistic beliefs about the potential to prevent and to cure cancer correlate with rather than cause cancer-related information seeking. However, self-efficacy about the confidence in finding needed cancer information was a significant predictor of information-seeking. %M 32821061 %R 10.2196/16138 %U http://cancer.jmir.org/2020/2/e16138/ %U https://doi.org/10.2196/16138 %U http://www.ncbi.nlm.nih.gov/pubmed/32821061 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20923 %T General Public’s Information-Seeking Patterns of Topics Related to Obesity: Google Trends Analysis %A Pawar,Aditya S %A Nagpal,Sajan %A Pawar,Neha %A Lerman,Lilach O %A Eirin,Alfonso %+ Division of Nephrology, Mayo Clinic, 200 First Street SW, Rochester, MN, , United States, 1 5078844863, eirinmassat.alfonso@mayo.edu %K obesity %K normalization %K public awareness %K infodemiology %K infoveillance %D 2020 %7 11.8.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Obesity is a major public health challenge, and recent literature sheds light on the concept of “normalization” of obesity. Objective: We aimed to study the worldwide pattern of web-based information seeking by public on obesity and on its related terms and topics using Google Trends. Methods: We compared the relative frequency of obesity-related search terms and topics between 2004 and 2019 on Google Trends. The mean relative interest scores for these terms over the 4-year quartiles were compared. Results: The mean relative interest score of the search term “obesity” consistently decreased with time in all four quartiles (2004-2019), whereas the relative interest scores of the search topics “weight loss” and “abdominal obesity” increased. The topic “weight loss” was popular during the month of January, and its median relative interest score for January was higher than that for other months for the entire study period (P<.001). The relative interest score for the search term “obese” decreased over time, whereas those scores for the terms “body positivity” and “self-love” increased after 2013. Conclusions: Despite a worldwide increase in the prevalence of obesity, its popularity as an internet search term diminished over time. The reason for peaks in months should be explored and applied to the awareness campaigns for better effectiveness. These patterns suggest normalization of obesity in society and a rise of public curiosity about image-related obesity rather than its medical implications and harm. %M 32633725 %R 10.2196/20923 %U http://publichealth.jmir.org/2020/3/e20923/ %U https://doi.org/10.2196/20923 %U http://www.ncbi.nlm.nih.gov/pubmed/32633725 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17907 %T Information Needs of Breast Cancer Patients: Theory-Generating Meta-Synthesis %A Lu,Hongru %A Xie,Juan %A Gerido,Lynette Hammond %A Cheng,Ying %A Chen,Ya %A Sun,Lizhu %+ School of Information Management, Nanjing University, 163 Xianlin Avenue, Nanjing, China, 86 138 5183 8364, chengy@nju.edu.cn %K breast cancer patients %K information needs %K incentives %K moderating variables %K meta-synthesis %D 2020 %7 28.7.2020 %9 Review %J J Med Internet Res %G English %X Background: Breast cancer has become one of the most frequently diagnosed carcinomas and the leading cause of cancer deaths. The substantial growth in the number of breast cancer patients has put great pressure on health services. Meanwhile, the information patients need has increased and become more complicated. Therefore, a comprehensive and in-depth understanding of their information needs is urgently needed to improve the quality of health care. However, previous studies related to the information needs of breast cancer patients have focused on different perspectives and have only contributed to individual results. A systematic review and synthesis of breast cancer patients’ information needs is critical. Objective: This paper aims to systematically identify, evaluate, and synthesize existing primary qualitative research on the information needs of breast cancer patients. Methods: Web of Science, EBSCO, Scopus, ProQuest, PubMed, PsycINFO, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature were searched on February 12 and July 9, 2019, to collect relevant studies. A Google Scholar search, interpersonal network recommendations, and reference chaining were also conducted. Eligible studies included qualitative or mixed-methods studies focusing on the information needs (across the cancer continuum) of breast cancer patients or their social networks. Subsequently, a Critical Appraisals Skills Programme checklist was used to assess the quality of included research. The results, findings, and discussions were extracted. Data analysis was guided by the theory-generating meta-synthesis and grounded theory approach. Results: Three themes, 19 categories, and 55 concepts emerged: (1) incentives (physical abnormality, inquiry from others, subjective norm, and problems during appointments); (2) types of information needs (prevention, etiology, diagnosis, clinical manifestation, treatment, prognosis, impact and resumption of normal life, scientific research, and social assistance); (3) moderating variables (attitudes, health literacy, demographic characteristics, disease status, as well as political and cultural environment). The studies revealed that the information needs of breast cancer patients were triggered by different incentives. Subsequently, the patients sought a variety of information among different stages of the cancer journey. Five types of variables were also found to moderate the formation of information needs. Conclusions: This study contributes to a thorough model of information needs among breast cancer patients and provides practical suggestions for health and information professionals. %M 32720899 %R 10.2196/17907 %U https://www.jmir.org/2020/7/e17907 %U https://doi.org/10.2196/17907 %U http://www.ncbi.nlm.nih.gov/pubmed/32720899 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17502 %T Biased Sampling and Causal Estimation of Health-Related Information: Laboratory-Based Experimental Research %A Moreno-Fernández,María Manuela %A Matute,Helena %+ Departamento de Fundamentos y Métodos de la Psicología, Faculty of Psychology and Education, University of Deusto, Avenida de las Universidades, 24, Bilbao, 48007, Spain, 34 944 139 000 ext 3229, manuela.moreno@deusto.es %K information sampling %K causal illusion %K causal bias %K health information %K health communication %D 2020 %7 24.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet is a relevant source of health-related information. The huge amount of information available on the internet forces users to engage in an active process of information selection. Previous research conducted in the field of experimental psychology showed that information selection itself may promote the development of erroneous beliefs, even if the information collected does not. Objective: The aim of this study was to assess the relationship between information searching strategy (ie, which cues are used to guide information retrieval) and causal inferences about health while controlling for the effect of additional information features. Methods: We adapted a standard laboratory task that has previously been used in research on contingency learning to mimic an information searching situation. Participants (N=193) were asked to gather information to determine whether a fictitious drug caused an allergic reaction. They collected individual pieces of evidence in order to support or reject the causal relationship between the two events by inspecting individual cases in which the drug was or was not used or in which the allergic reaction appeared or not. Thus, one group (cause group, n=105) was allowed to sample information based on the potential cause, whereas a second group (effect group, n=88) was allowed to sample information based on the effect. Although participants could select which medical records they wanted to check—cases in which the medicine was used or not (in the cause group) or cases in which the effect appeared or not (in the effect group)—they all received similar evidence that indicated the absence of a causal link between the drug and the reaction. After observing 40 cases, they estimated the drug–allergic reaction causal relationship. Results: Participants used different strategies for collecting information. In some cases, participants displayed a biased sampling strategy compatible with positive testing, that is, they required a high proportion of evidence in which the drug was administered (in the cause group) or in which the allergic reaction appeared (in the effect group). Biased strategies produced an overrepresentation of certain pieces of evidence at the detriment of the representation of others, which was associated with the accuracy of causal inferences. Thus, how the information was collected (sampling strategy) demonstrated a significant effect on causal inferences (F1,185=32.53, P<.001, η2p=0.15) suggesting that inferences of the causal relationship between events are related to how the information is gathered. Conclusions: Mistaken beliefs about health may arise from accurate pieces of information partially because of the way in which information is collected. Patient or person autonomy in gathering health information through the internet, for instance, may contribute to the development of false beliefs from accurate pieces of information because search strategies can be biased. %M 32706735 %R 10.2196/17502 %U http://www.jmir.org/2020/7/e17502/ %U https://doi.org/10.2196/17502 %U http://www.ncbi.nlm.nih.gov/pubmed/32706735 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18527 %T Causal Effect of Honorary Titles on Physicians’ Service Volumes in Online Health Communities: Retrospective Study %A Yu,Haiyan %A Wang,Yali %A Wang,Jying-Nan %A Chiu,Ya-Ling %A Qiu,Hang %A Gao,Mingyue %+ Life Course Epidemiology and Biostatistics, Population, Policy, and Practice Programme, Great Ormond Street Institute of Child Health, University College London, Guilford Street, London, WC1N 1EH, United Kingdom, 44 07410372022, ming.gao.17@ucl.ac.uk %K causality %K health information systems %K organizational policy %K physician-patient relations %K remote consultation %D 2020 %7 9.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: An OHC online health community (OHC) is an interactive platform for virtual communication between patients and physicians. Patients can typically search, seek, and share their experience and rate physicians, who may be involved in giving advice. Some OHC providers provide incentives in form of honorary titles to encourage the web-based involvement of physicians, but it is unclear whether the award of honorary titles has an impact on their consultation volume in an OHC. Objective: This study is designed to identify the differential treatment effect of the incentive policy on the service volumes for the subgroups of treatment and control in an OHC. This study aims to answer the following questions: Does an honorary title for physicians impact their service volumes in an OHC? During the period of discontinuity, can we identify the sharp effect of the incentive award on the outcomes of physicians’ service volumes? Methods: We acquired the targeted samples based on treatment, namely, physicians with an honorary title or not and outcomes measured before and after the award of the 2 subgroups. A regression discontinuity design was applied to investigate the impact of the honorary titles incentive as a treatment in an OHC. There was a sharply discontinuous effect of treatment on physicians’ online health service performance. The experimental data set consisted of 346 physicians in the treatment group (with honorary titles). Applying the propensity score matching method, the same size of physicians (n=346) was matched and selected as the control group. Results: A sharp discontinuity was found at the time of the physician receiving the honorary title. The results showed that the parametric estimates of the coefficient were significantly positively (P<.001) associated with monthly home page views. The jump in the monthly volumes of home page views was much sharper than that of the monthly consultations. Conclusions: The changes in the volumes of monthly consultations and home page views reflect the differential treatment effect of honorary titles on physicians’ service volumes. The effect of the incentive policy with honorary titles is objectively estimated from both the perspective of online and offline medical services in an OHC. Being named with honorary titles significantly multiplied monthly home page views, yet it did not significantly impact monthly consultations. This may be because consultation capacity is limited by the physician's schedule for consultations. %M 32673232 %R 10.2196/18527 %U https://www.jmir.org/2020/7/e18527 %U https://doi.org/10.2196/18527 %U http://www.ncbi.nlm.nih.gov/pubmed/32673232 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e18441 %T Diabetes Self-Management in the Age of Social Media: Large-Scale Analysis of Peer Interactions Using Semiautomated Methods %A Myneni,Sahiti %A Lewis,Brittney %A Singh,Tavleen %A Paiva,Kristi %A Kim,Seon Min %A Cebula,Adrian V %A Villanueva,Gloria %A Wang,Jing %+ University of Texas School of Biomedical Informatics at Houston, 7000 Fannin Street, Suite 600, Houston, TX, 77030, United States, 1 7134860115, sahiti.myneni@uth.tmc.edu %K diabetes %K self-management %K social media %K digital health %D 2020 %7 30.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Online communities have been gaining popularity as support venues for chronic disease management. User engagement, information exposure, and social influence mechanisms can play a significant role in the utility of these platforms. Objective: In this paper, we characterize peer interactions in an online community for chronic disease management. Our objective is to identify key communications and study their prevalence in online social interactions. Methods: The American Diabetes Association Online community is an online social network for diabetes self-management. We analyzed 80,481 randomly selected deidentified peer-to-peer messages from 1212 members, posted between June 1, 2012, and May 30, 2019. Our mixed methods approach comprised qualitative coding and automated text analysis to identify, visualize, and analyze content-specific communication patterns underlying diabetes self-management. Results: Qualitative analysis revealed that “social support” was the most prevalent theme (84.9%), followed by “readiness to change” (18.8%), “teachable moments” (14.7%), “pharmacotherapy” (13.7%), and “progress” (13.3%). The support vector machine classifier resulted in reasonable accuracy with a recall of 0.76 and precision 0.78 and allowed us to extend our thematic codes to the entire data set. Conclusions: Modeling health-related communication through high throughput methods can enable the identification of specific content related to sustainable chronic disease management, which facilitates targeted health promotion. %M 32602843 %R 10.2196/18441 %U https://medinform.jmir.org/2020/6/e18441 %U https://doi.org/10.2196/18441 %U http://www.ncbi.nlm.nih.gov/pubmed/32602843 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15099 %T Lifestyle Segmentation to Explain the Online Health Information–Seeking Behavior of Older Adults: Representative Telephone Survey %A Weber,Winja %A Reinhardt,Anne %A Rossmann,Constanze %+ University of Erfurt, Nordhaeuser Str 63, Erfurt, Germany, 49 361 737 4175, winja.weber@uni-erfurt.de %K older adults %K online health information seeking %K lifestyle %K segmentation %K cluster analysis %D 2020 %7 12.6.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32530433 %R 10.2196/15099 %U http://www.jmir.org/2020/6/e15099/ %U https://doi.org/10.2196/15099 %U http://www.ncbi.nlm.nih.gov/pubmed/32530433 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e20021 %T COVID-19-Related Information Sources and the Relationship With Confidence in People Coping with COVID-19: Facebook Survey Study in Taiwan %A Wang,Peng-Wei %A Lu,Wei-Hsin %A Ko,Nai-Ying %A Chen,Yi-Lung %A Li,Dian-Jeng %A Chang,Yu-Ping %A Yen,Cheng-Fang %+ Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan, 886 7 3121101 ext 6822, chfaye@cc.kmu.edu.tw %K COVID-19 %K information %K internet %K coping %K confidence %K mental health %K social media %K Facebook %K survey %K online health information %D 2020 %7 5.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People obtain information on the coronavirus disease (COVID-19) from the internet and other sources. Understanding the factors related to such information sources aids health professionals in educating individuals. Objective: This study used data collected from the online survey study on COVID-19 in Taiwan to examine what major COVID-19 information sources are available and which sources are significantly related to the self-confidence of people in coping with COVID-19 in Taiwan. Methods: A total of 1904 participants (1270 non–health-care workers and 634 health care workers) were recruited from the Facebook advertisement. Their major sources of information about COVID-19, the relationships between the sources and demographic factors, and the relationships between the sources and the self-confidence in coping with COVID-19 were surveyed. Results: Most Taiwanese people relied on the internet for COVID-19 information. Many respondents also used a variety of sources of information on COVID-19; such variety was associated with sex, age, and the level of worry toward COVID-19, as well as if one was a health care worker. For health care workers, the use of formal lessons as an information source was significantly associated with better self-confidence in coping with COVID-19. The significant association between receiving information from more sources and greater self-confidence was found only in health care workers but not in non–health-care workers. Conclusions: Medical professionals should consider subgroups of the population when establishing various means to deliver information on COVID-19. %M 32490839 %R 10.2196/20021 %U http://www.jmir.org/2020/6/e20021/ %U https://doi.org/10.2196/20021 %U http://www.ncbi.nlm.nih.gov/pubmed/32490839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19930 %T Considerations for an Individual-Level Population Notification System for Pandemic Response: A Review and Prototype %A Sakib,Mohammad Nazmus %A Butt,Zahid A %A Morita,Plinio Pelegrini %A Oremus,Mark %A Fong,Geoffrey T %A Hall,Peter A %+ School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 38110, pahall@uwaterloo.ca %K pandemic %K epidemic %K notification system %K hygiene %K physical distancing %K lockdown %K mobile technology %K COVID-19 %K coronavirus %D 2020 %7 5.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X The outbreak of the coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, spread worldwide after its emergence in China. Whether rich or poor, all nations are struggling to cope with this new global health crisis. The speed of the threat’s emergence and the quick response required from public health authorities and the public itself makes evident the need for a major reform in pandemic surveillance and notification systems. The development and implementation of a graded, individual-level pandemic notification system could be an effective tool to combat future threats of epidemics. This paper describes a prototype model of such a notification system and its potential advantages and challenges for implementation. Similar to other emergency alerts, this system would include a number of threat levels (level 1-5) with a higher level indicating increasing severity and intensity of safety measures (eg, level 1: general hygiene, level 2: enhanced hygiene, level 3: physical distancing, level 4: shelter in place, and level 5: lockdown). The notifications would be transmitted to cellular devices via text message (for lower threat levels) or push notification (for higher threat levels). The notification system would allow the public to be informed about the threat level in real time and act accordingly in an organized manner. New Zealand and the United Kingdom have recently launched similar alert systems designed to coordinate the ongoing COVID-19 pandemic response more efficiently. Implementing such a system, however, faces multiple challenges. Extensive preparation and coordination among all levels of government and relevant sectors are required. Additionally, such systems may be effective primarily in countries where there exists at least moderate trust in government. Advance and ongoing public education about the nature of the system and its steps would be an essential part of the system, such that all members of the public understand the meaning of each step in advance, similar to what has been established in systems for other emergency responses. This educational component is of utmost importance to minimize adverse public reaction and unintended consequences. The use of mass media and local communities could be considered where mobile phone penetration is low. The implementation of such a notification system would be more challenging in developing countries for several reasons, including inadequate technology, limited use of data plans, high population density, poverty, mistrust in government, and tendency to ignore or failure to understand the warning messages. Despite the challenges, an individual-level pandemic notification system could provide added benefits by giving an additional route for notification that would be complementary to existing platforms. %M 32484443 %R 10.2196/19930 %U http://www.jmir.org/2020/6/e19930/ %U https://doi.org/10.2196/19930 %U http://www.ncbi.nlm.nih.gov/pubmed/32484443 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e12799 %T Identification of the Best Semantic Expansion to Query PubMed Through Automatic Performance Assessment of Four Search Strategies on All Medical Subject Heading Descriptors: Comparative Study %A Massonnaud,Clément R %A Kerdelhué,Gaétan %A Grosjean,Julien %A Lelong,Romain %A Griffon,Nicolas %A Darmoni,Stefan J %+ Department of Biomedical Informatics, Rouen University Hospital, 1 rue de Germont, Rouen, France, 33 2 32 88 89 90, clement.massonnaud@gmail.com %K bibliographic database %K information retrieval %K literature search %K Medical Subject Headings %K MEDLINE %K PubMed %K precision %K recall %K search strategy %K thesaurus %D 2020 %7 4.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: With the continuous expansion of available biomedical data, efficient and effective information retrieval has become of utmost importance. Semantic expansion of queries using synonyms may improve information retrieval. Objective: The aim of this study was to automatically construct and evaluate expanded PubMed queries of the form “preferred term”[MH] OR “preferred term”[TIAB] OR “synonym 1”[TIAB] OR “synonym 2”[TIAB] OR …, for each of the 28,313 Medical Subject Heading (MeSH) descriptors, by using different semantic expansion strategies. We sought to propose an innovative method that could automatically evaluate these strategies, based on the three main metrics used in information science (precision, recall, and F-measure). Methods: Three semantic expansion strategies were assessed. They differed by the synonyms used to build the queries as follows: MeSH synonyms, Unified Medical Language System (UMLS) mappings, and custom mappings (Catalogue et Index des Sites Médicaux de langue Française [CISMeF]). The precision, recall, and F-measure metrics were automatically computed for the three strategies and for the standard automatic term mapping (ATM) of PubMed. The method to automatically compute the metrics involved computing the number of all relevant citations (A), using National Library of Medicine indexing as the gold standard (“preferred term”[MH]), the number of citations retrieved by the added terms (”synonym 1“[TIAB] OR ”synonym 2“[TIAB] OR …) (B), and the number of relevant citations retrieved by the added terms (combining the previous two queries with an “AND” operator) (C). It was possible to programmatically compute the metrics for each strategy using each of the 28,313 MeSH descriptors as a “preferred term,” corresponding to 239,724 different queries built and sent to the PubMed application program interface. The four search strategies were ranked and compared for each metric. Results: ATM had the worst performance for all three metrics among the four strategies. The MeSH strategy had the best mean precision (51%, SD 23%). The UMLS strategy had the best recall and F-measure (41%, SD 31% and 36%, SD 24%, respectively). CISMeF had the second best recall and F-measure (40%, SD 31% and 35%, SD 24%, respectively). However, considering a cutoff of 5%, CISMeF had better precision than UMLS for 1180 descriptors, better recall for 793 descriptors, and better F-measure for 678 descriptors. Conclusions: This study highlights the importance of using semantic expansion strategies to improve information retrieval. However, the performances of a given strategy, relatively to another, varied greatly depending on the MeSH descriptor. These results confirm there is no ideal search strategy for all descriptors. Different semantic expansions should be used depending on the descriptor and the user’s objectives. Thus, we developed an interface that allows users to input a descriptor and then proposes the best semantic expansion to maximize the three main metrics (precision, recall, and F-measure). %M 32496201 %R 10.2196/12799 %U https://medinform.jmir.org/2020/6/e12799 %U https://doi.org/10.2196/12799 %U http://www.ncbi.nlm.nih.gov/pubmed/32496201 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19455 %T Online Information Exchange and Anxiety Spread in the Early Stage of the Novel Coronavirus (COVID-19) Outbreak in South Korea: Structural Topic Model and Network Analysis %A Jo,Wonkwang %A Lee,Jaeho %A Park,Junli %A Kim,Yeol %+ National Cancer Control Institute, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea, 82 31 920 1753, drheat@ncc.re.kr %K coronavirus %K anxiety %K pandemic %K online %K health information exchange %K topic modeling %D 2020 %7 2.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In case of a population-wide infectious disease outbreak, such as the novel coronavirus disease (COVID-19), people’s online activities could significantly affect public concerns and health behaviors due to difficulty in accessing credible information from reliable sources, which in turn causes people to seek necessary information on the web. Therefore, measuring and analyzing online health communication and public sentiment is essential for establishing effective and efficient disease control policies, especially in the early stage of an outbreak. Objective: This study aimed to investigate the trends of online health communication, analyze the focus of people’s anxiety in the early stages of COVID-19, and evaluate the appropriateness of online information. Methods: We collected 13,148 questions and 29,040 answers related to COVID-19 from Naver, the most popular Korean web portal (January 20, 2020, to March 2, 2020). Three main methods were used in this study: (1) the structural topic model was used to examine the topics in the online questions; (2) word network analysis was conducted to analyze the focus of people’s anxiety and worry in the questions; and (3) two medical doctors assessed the appropriateness of the answers to the questions, which were primarily related to people’s anxiety. Results: A total of 50 topics and 6 cohesive topic communities were identified from the questions. Among them, topic community 4 (suspecting COVID-19 infection after developing a particular symptom) accounted for the largest portion of the questions. As the number of confirmed patients increased, the proportion of topics belonging to topic community 4 also increased. Additionally, the prolonged situation led to a slight increase in the proportion of topics related to job issues. People’s anxieties and worries were closely related with physical symptoms and self-protection methods. Although relatively appropriate to suspect physical symptoms, a high proportion of answers related to self-protection methods were assessed as misinformation or advertisements. Conclusions: Search activity for online information regarding the COVID-19 outbreak has been active. Many of the online questions were related to people’s anxieties and worries. A considerable portion of corresponding answers had false information or were advertisements. The study results could contribute reference information to various countries that need to monitor public anxiety and provide appropriate information in the early stage of an infectious disease outbreak, including COVID-19. Our research also contributes to developing methods for measuring public opinion and sentiment in an epidemic situation based on natural language data on the internet. %M 32463367 %R 10.2196/19455 %U https://www.jmir.org/2020/6/e19455 %U https://doi.org/10.2196/19455 %U http://www.ncbi.nlm.nih.gov/pubmed/32463367 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e17349 %T Multidimensional Feature Classification of the Health Information Needs of Patients With Hypertension in an Online Health Community Through Analysis of 1000 Patient Question Records: Observational Study %A Luo,Aijing %A Xin,Zirui %A Yuan,Yifeng %A Wen,Tingxiao %A Xie,Wenzhao %A Zhong,Zhuqing %A Peng,Xiaoqing %A Ouyang,Wei %A Hu,Chao %A Liu,Fei %A Chen,Yang %A He,Haiyan %+ The Third Xiangya Hospital of Central South University, No.138 Tongzipo Road, Changsha, 410013, China, 86 0731 8861 8316, xinzirui@csu.edu.cn %K online health community %K health information needs %K patients with hypertension %K physician-patient communication %D 2020 %7 29.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rapid development of online health communities, increasing numbers of patients and families are seeking health information on the internet. Objective: This study aimed to discuss how to fully reveal the health information needs expressed by patients with hypertension in their questions in a web-based environment and how to use the internet to help patients with hypertension receive personalized health education. Methods: This study randomly selected 1000 text records from the question data of patients with hypertension from 2008 to 2018 collected from Good Doctor Online and constructed a classification system through literature research and content analysis. This paper identified the background characteristics and questioning intention of each patient with hypertension based on the patient’s question and used co-occurrence network analysis and the k-means clustering method to explore the features of the health information needs of patients with hypertension. Results: The classification system for the health information needs of patients with hypertension included the following nine dimensions: drugs (355 names), symptoms and signs (395 names), tests and examinations (545 names), demographic data (526 kinds), diseases (80 names), risk factors (37 names), emotions (43 kinds), lifestyles (6 kinds), and questions (49 kinds). There were several characteristics of the explored web-based health information needs of patients with hypertension. First, more than 49% of patients described features, such as drugs, symptoms and signs, tests and examinations, demographic data, and diseases. Second, patients with hypertension were most concerned about treatment (778/1000, 77.80%), followed by diagnosis (323/1000, 32.30%). Third, 65.80% (658/1000) of patients asked physicians several questions at the same time. Moreover, 28.30% (283/1000) of patients were very concerned about how to adjust the medication, and they asked other treatment-related questions at the same time, including drug side effects, whether to take the drugs, how to treat the disease, etc. Furthermore, 17.60% (176/1000) of patients consulted physicians about the causes of clinical findings, including the relationship between the clinical findings and a disease, the treatment of a disease, and medications and examinations. Fourth, by k-means clustering, the questioning intentions of patients with hypertension were classified into the following seven categories: “how to adjust medication,” “what to do,” “how to treat,” “phenomenon explanation,” “test and examination,” “disease diagnosis,” and “disease prognosis.” Conclusions: In a web-based environment, the health information needs expressed by Chinese patients with hypertension to physicians are common and distinct, that is, patients with different background features ask relatively common questions to physicians. The classification system constructed in this study can provide guidance to health information service providers for the construction of web-based health resources, as well as guidance for patient education, which could help solve the problem of information asymmetry in communication between physicians and patients. %M 32469318 %R 10.2196/17349 %U http://www.jmir.org/2020/5/e17349/ %U https://doi.org/10.2196/17349 %U http://www.ncbi.nlm.nih.gov/pubmed/32469318 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e17002 %T Exploring the Vast Choice of Question Prompt Lists Available to Health Consumers via Google: Environmental Scan %A Tracy,Marguerite Clare %A Shepherd,Heather L %A Patel,Pinika %A Trevena,Lyndal Jane %+ Ask, Share, Know: Rapid Evidence for General Practice Decisions Centre for Research Excellence, School of Public Health, The University of Sydney, Room 323A, Edward Ford Building A27, NSW, 2006, Australia, 61 293512942, marguerite.tracy@sydney.edu.au %K question prompt list %K shared decision making %K environmental scan %D 2020 %7 29.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There is increasing interest in shared decision making (SDM) in Australia. Question prompt lists (QPLs) support question asking by patients, a key part of SDM. QPLs have been studied in a variety of settings, and increasingly the internet provides a source of suggested questions for patients. Environmental scans have been shown to be useful in assessing the availability and quality of online SDM tools. Objective: This study aimed to assess the number and readability of QPLs available to users via Google.com.au. Methods: Our environmental scan used search terms derived from literature and reputable websites to search for QPLs available via Google.com.au. Following removal of duplicates from the 4000 URLs and 22 reputable sites, inclusion and exclusion criteria were applied to create a list of unique QPLs. A sample of 20 QPLs was further assessed for list length, proxy measures of quality such as a date of review, and evidence of doctor endorsement. Readability of the sample QPL instructions and QPLs themselves was assessed using Flesch Reading Ease and Flesch-Kincaid Grade Level scores. Results: Our environmental scan identified 173 unique QPLs available to users. Lists ranged in length from 1 question to >200 questions. Of our sample, 50% (10/20) had a listed date of creation or update, and 60% (12/20) had evidence of authorship or source. Flesch-Kincaid Grade Level scores for instructions were higher than for the QPLs (grades 10.3 and 7.7, respectively). There was over a 1 grade difference between QPLs from reputable sites compared with other sites (grades 4.2 and 5.4, respectively). Conclusions: People seeking questions to ask their doctor using Google.com.au encounter a vast number of question lists that they can use to prepare for consultations with their doctors. Markers of the quality or usefulness of various types of online QPLs, either surrogate or direct, have not yet been established, which makes it difficult to assess the value of the abundance of lists. Doctor endorsement of question asking has previously been shown to be an important factor in the effectiveness of QPLs, but information regarding this is not readily available online. Whether these diverse QPLs are endorsed by medical practitioners warrants further investigation. %M 32469321 %R 10.2196/17002 %U http://www.jmir.org/2020/5/e17002/ %U https://doi.org/10.2196/17002 %U http://www.ncbi.nlm.nih.gov/pubmed/32469321 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16281 %T Internet-Based Health Information–Seeking Behavior of Students Aged 12 to 14 Years: Mixed Methods Study %A Maitz,Emanuel %A Maitz,Katharina %A Sendlhofer,Gerald %A Wolfsberger,Christina %A Mautner,Selma %A Kamolz,Lars-Peter %A Gasteiger-Klicpera,Barbara %+ Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, Graz, A-8036, Austria, 43 6604756105, emanuel.maitz@stud.medunigraz.at %K internet-based health information–seeking behavior %K eHealth literacy %K children and adolescents %K mixed methods study %D 2020 %7 26.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Many children and adolescents are surrounded by smartphones, tablets, and computers and know how to search the internet for almost any information. However, very few of them know how to select proper information from reliable sources. This can become a problem when health issues are concerned, where it is vital to identify incorrect or misleading information. The competence to critically evaluate digital information on health issues is of increasing importance for adolescents. Objective: The aim of this study was to assess how children and adolescents rate their internet-based health literacy and how their actual literacy differs from their ratings. In addition, there was a question on how their search performance is related to their self-efficacy. To evaluate these questions, a criteria-based analysis of the quality of the websites they visited was performed. Finally, the possibility to increase their internet-based health literacy in a 3-day workshop was explored. Methods: A workshop with a focus on health literacy was attended by 14 children and adolescents in an Austrian secondary school. After prior assessments (Culture Fair Intelligence Test, revised German version; Reading Speed and Reading Comprehension Test for Grades 6 to 12, German; electronic health literacy scale [eHEALS]; and General Self-Efficacy Scale, Reversed Version, German), the students were asked to perform an internet-based search on a health-related issue. Browser histories and screenshots of all internet searches were gathered, clustered, and analyzed. After the workshop, the health literacy of the students was assessed again by using the eHEALS. Results: The 14 students opened a total of 85 homepages, but only eight of these homepages were rated as good or fair by two experts (independent rating) based on specific criteria. The analysis showed that the students judged their own internet-based health literacy much higher than the actual value, and students who had rated themselves better did not visit websites of high quality. Internet-based health literacy correlated significantly with the self-efficacy of the students (rs=0.794, P=.002). Conclusions: Our study showed that it is possible to draw the attention of students to critical aspects of internet search and to slightly improve their search competence in a workshop. Targeted improvement of health literacy is urgently required, and students need special instruction for this purpose. Further investigations in this area with larger sets of data, which could be feasible with the help of a computer program, are urgently needed. %M 32209532 %R 10.2196/16281 %U https://www.jmir.org/2020/5/e16281 %U https://doi.org/10.2196/16281 %U http://www.ncbi.nlm.nih.gov/pubmed/32209532 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e15817 %T A Cross-Cultural Comparison of an Extended Planned Risk Information Seeking Model on Mental Health Among College Students: Cross-Sectional Study %A Niu,Zhaomeng %A Willoughby,Jessica Fitts %A Mei,Jing %A Li,Shaochun %A Hu,Pengwei %+ AI for Healthcare, IBM Research, 19 Zhonguancun Software Park, 8 Dong Bei Wang Xi Lu, Haidian Qu,, Beijing, 100085, China, 86 10 58748625, hupwei@cn.ibm.com %K information seeking behavior %K mental health %K cross-cultural comparison %D 2020 %7 11.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Approximately 42.5 million adults have been affected by mental illness in the United States in 2013, and 173 million people have been affected by a diagnosable psychiatric disorder in China. An increasing number of people tend to seek health information on the Web, and it is important to understand the factors associated with individuals’ mental health information seeking. Identifying factors associated with mental health information seeking may influence the disease progression of potential patients. The planned risk information seeking model (PRISM) was developed in 2010 by integrating multiple information seeking models including the theory of planned behavior. Few studies have replicated PRISM outside the United States and no previous study has examined mental health as a personal risk in different cultures. Objective: This study aimed to test the planned risk information seeking model (PRISM) in China and the United States with a chronic disease, mental illness, and two additional factors, ie, media use and cultural identity, among college students. Methods: Data were collected in both countries using the same online survey through a survey management program (Qualtrics). In China, college instructors distributed the survey link among university students, and it was also posted on a leading social media site called Sina Weibo. In the United States, the data were collected in a college-wide survey pool in a large Northwestern university. Results: The final sample size was 235 for the Chinese sample and 241 for the US sample. Media use was significantly associated with mental health information–seeking intentions in the Chinese sample (P<.001), and cultural identity was significantly associated with intentions in both samples (China: P=.02; United States: P<.001). The extended PRISM had a better model fit than the original PRISM. Conclusions: Cultural identity and media use should be considered when evaluating the process of mental health information seeking or when designing interventions to address mental health information seeking. %M 32441654 %R 10.2196/15817 %U http://www.jmir.org/2020/5/e15817/ %U https://doi.org/10.2196/15817 %U http://www.ncbi.nlm.nih.gov/pubmed/32441654 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19087 %T Mining the Characteristics of COVID-19 Patients in China: Analysis of Social Media Posts %A Huang,Chunmei %A Xu,Xinjie %A Cai,Yuyang %A Ge,Qinmin %A Zeng,Guangwang %A Li,Xiaopan %A Zhang,Weide %A Ji,Chen %A Yang,Ling %+ Department of Geriatrics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China, 86 13651608005, yangling01@xinhuamed.com.cn %K SARS-CoV-2 %K COVID-19 %K coronavirus disease %K social media %K Sina Weibo %K help %D 2020 %7 17.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In December 2019, pneumonia cases of unknown origin were reported in Wuhan City, Hubei Province, China. Identified as the coronavirus disease (COVID-19), the number of cases grew rapidly by human-to-human transmission in Wuhan. Social media, especially Sina Weibo (a major Chinese microblogging social media site), has become an important platform for the public to obtain information and seek help. Objective: This study aims to analyze the characteristics of suspected or laboratory-confirmed COVID-19 patients who asked for help on Sina Weibo. Methods: We conducted data mining on Sina Weibo and extracted the data of 485 patients who presented with clinical symptoms and imaging descriptions of suspected or laboratory-confirmed cases of COVID-19. In total, 9878 posts seeking help on Sina Weibo from February 3 to 20, 2020 were analyzed. We used a descriptive research methodology to describe the distribution and other epidemiological characteristics of patients with suspected or laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection. The distance between patients’ home and the nearest designated hospital was calculated using the geographic information system ArcGIS. Results: All patients included in this study who sought help on Sina Weibo lived in Wuhan, with a median age of 63.0 years (IQR 55.0-71.0). Fever (408/485, 84.12%) was the most common symptom. Ground-glass opacity (237/314, 75.48%) was the most common pattern on chest computed tomography; 39.67% (167/421) of families had suspected and/or laboratory-confirmed family members; 36.58% (154/421) of families had 1 or 2 suspected and/or laboratory-confirmed members; and 70.52% (232/329) of patients needed to rely on their relatives for help. The median time from illness onset to real-time reverse transcription-polymerase chain reaction (RT-PCR) testing was 8 days (IQR 5.0-10.0), and the median time from illness onset to online help was 10 days (IQR 6.0-12.0). Of 481 patients, 32.22% (n=155) lived more than 3 kilometers away from the nearest designated hospital. Conclusions: Our findings show that patients seeking help on Sina Weibo lived in Wuhan and most were elderly. Most patients had fever symptoms, and ground-glass opacities were noted in chest computed tomography. The onset of the disease was characterized by family clustering and most families lived far from the designated hospital. Therefore, we recommend the following: (1) the most stringent centralized medical observation measures should be taken to avoid transmission in family clusters; and (2) social media can help these patients get early attention during Wuhan’s lockdown. These findings can help the government and the health department identify high-risk patients and accelerate emergency responses following public demands for help. %M 32401210 %R 10.2196/19087 %U http://www.jmir.org/2020/5/e19087/ %U https://doi.org/10.2196/19087 %U http://www.ncbi.nlm.nih.gov/pubmed/32401210 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 5 %P e16793 %T Effect of Online Health Information Seeking on Anxiety in Hospitalized Pregnant Women: Cohort Study %A Coglianese,Fabiana %A Beltrame Vriz,Giulia %A Soriani,Nicola %A Piras,Gianluca Niccolò %A Comoretto,Rosanna Irene %A Clemente,Laura %A Fasan,Jessica %A Cristiano,Lucia %A Schiavinato,Valentina %A Adamo,Valter %A Marchesoni,Diego %A Gregori,Dario %+ Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Loredan 18, Padua, 35121, Italy, 39 0498275384, dario.gregori@unipd.it %K anxiety %K pregnant women %K web health information %K internet use %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: There are approximately 1,000,000 pregnant women at high risk for obstetric complications per year, more than half of whom require hospitalization. Objective: The aim of this study was to determine the relation between online health information seeking and anxiety levels in a sample of hospitalized woman with pregnancy-related complications. Methods: A sample of 105 pregnant women hospitalized in northern Italy, all with an obstetric complication diagnosis, completed different questionnaires: Use of Internet Health-information (UIH) questionnaire about use of the internet, EuroQOL 5 dimensions (EQ-5D) questionnaire on quality of life, State-Trait Anxiety Inventory (STAI) questionnaire measuring general anxiety levels, and a questionnaire about critical events occurring during hospitalization. Results: Overall, 98/105 (93.3%) of the women used the internet at home to obtain nonspecific information about health in general and 95/105 (90.5%) of the women used the internet to specifically search for information related to their obstetric disease. Online health information-seeking behavior substantially decreased the self-reported anxiety levels (P=.008). Conclusions: Web browsing for health information was associated with anxiety reduction, suggesting that the internet can be a useful instrument in supporting professional intervention to control and possibly reduce discomfort and anxiety for women during complicated pregnancies. %M 32374268 %R 10.2196/16793 %U https://medinform.jmir.org/2020/5/e16793 %U https://doi.org/10.2196/16793 %U http://www.ncbi.nlm.nih.gov/pubmed/32374268 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16768 %T Web-Based Medical Information Searching by Chinese Patients With Breast Cancer and its Influence on Survival: Observational Study %A Li,Yan %A Ye,Shan %A Zhou,Yidong %A Mao,Feng %A Guo,Hailing %A Lin,Yan %A Zhang,Xiaohui %A Shen,Songjie %A Shi,Na %A Wang,Xiaojie %A Sun,Qiang %+ Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China, 1 69158721, sunqiangpumch@126.com %K breast cancer %K internet %K disease-free survival %K breast conserving therapy %K online information %K satisfaction level %D 2020 %7 17.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet allows patients to easily look for health information. However, how Chinese patients with breast cancer use the internet has rarely been investigated, and there is a scarcity of information about the influence of internet use on survival. Objective: This observational study aimed to investigate the details of online medical information searching by Chinese patients with breast cancer and to determine whether internet use has any survival benefits. Methods: Patients who were diagnosed with invasive breast cancer at Peking Union Medical College Hospital between January 2014 and December 2015 were enrolled. We obtained information on their internet-searching behavior and gathered data from the patients’ medical and follow-up records. The associations between internet use and other clinic-pathological factors were analyzed. A Cox proportional-hazards model and the Kaplan-Meier method were used for disease-free survival (DFS) analyses. Results: A total of 973 patients with invasive breast cancer who underwent definitive surgery took part in the study. Among them, 477 cases (49.0%) performed web-based breast cancer information searching before the initial treatment. A multivariate logistic regression analysis suggested that web-based breast cancer information searching was significantly associated with younger age (odds ratio [OR] 0.95, 95% CI 0.94-0.97, P<.001), higher education level (OR 1.37, 95% CI 1.01–1.86, P=.04), and breast conserving surgery (OR 1.35, 95% CI 1.04-1.77, P=.03). Baidu (73.4%, 350/477) and WeChat (66.7%, 318/477) were the two most popular online information sources for breast cancer; however, only 44.9% (214/477) felt satisfied with the online information. In contrast to the nonweb searching group, the web-using patients who were satisfied with online information showed significantly improved DFS (hazard ratio 0.26; 95% CI 0.08-0.88, P=.03). Conclusions: The patients who were most likely to search the internet for breast cancer information were younger and well-educated, and they were more likely to have breast conserving therapy. Web-using patients who were satisfied with the internet information showed significantly improved DFS. Patients should browse credible websites offering accurate and updated information, and website developers should provide high-quality and easy-to-understand information to better meet the needs of patients with breast cancer. %M 32301740 %R 10.2196/16768 %U http://www.jmir.org/2020/4/e16768/ %U https://doi.org/10.2196/16768 %U http://www.ncbi.nlm.nih.gov/pubmed/32301740 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e13071 %T Patient Questions and Physician Responses in a Chinese Health Q&A Website: Content Analysis %A Hong,Ziying %A Deng,Zhaohua %A Evans,Richard %A Wu,Haiyan %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 19945036079, zh-deng@hust.edu.cn %K health information seeking %K question classification %D 2020 %7 16.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the turn of this century, the internet has become an invaluable resource for people seeking health information and answers to health-related queries. Health question and answer websites have grown in popularity in recent years as a means for patients to obtain health information from medical professionals. For patients suffering from chronic illnesses, it is vital that health care providers become better acquainted with patients’ information needs and learn how they express them in text format. Objective: The aims of this study were to: (1) explore whether patients can accurately and adequately express their information needs on health question and answer websites, (2) identify what types of problems are of most concern to those suffering from chronic illnesses, and (3) determine the relationship between question characteristics and the number of answers received. Methods: Questions were collected from a leading Chinese health question and answer website called “All questions will be answered” in January 2018. We focused on questions relating to diabetes and hepatitis, including those that were free and those that were financially rewarded. Content analysis was completed on a total of 7068 (diabetes) and 6685 (hepatitis) textual questions. Correlations between the characteristics of questions (number of words per question, value of reward) and the number of answers received were evaluated using linear regression analysis. Results: The majority of patients are able to accurately express their problem in text format, while some patients may require minor social support. The questions posted were related to three main topics: (1) prevention and examination, (2) diagnosis, and (3) treatment. Patients with diabetes were most concerned with the treatment received, whereas patients with hepatitis focused on the diagnosis results. The number of words per question and the value of the reward were negatively correlated with the number of answers. The number of words per question and the value of the reward were negatively correlated with the number of answers. Conclusions: This study provides valuable insights into the ability of patients suffering from chronic illnesses to make an understandable request on health question and answer websites. Health topics relating to diabetes and hepatitis were classified to address the health information needs of chronically ill patients. Furthermore, identification of the factors affecting the number of answers received per question can help users of these websites to better frame their questions to obtain more valuable answers. %M 32297872 %R 10.2196/13071 %U https://www.jmir.org/2020/4/e13071 %U https://doi.org/10.2196/13071 %U http://www.ncbi.nlm.nih.gov/pubmed/32297872 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16148 %T Development of an Instrument to Assess Parents’ Excessive Web-Based Searches for Information Pertaining to Their Children’s Health: The “Children’s Health Internet Research, Parental Inventory” (CHIRPI) %A Barke,Antonia %A Doering,Bettina K %+ Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Ostenstrasse 25, Eichstaett, 85072, Germany, 49 842193 ext 21842, abarke@gwdg.de %K hypochondriasis %K internet %K health behavior %K health knowledge, attitudes, practice %K questionnaire %K children %K parents %D 2020 %7 15.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People often search the internet to obtain health-related information not only for themselves but also for family members and, in particular, their children. However, for a minority of parents, such searches may become excessive and distressing. Little is known about excessive web-based searching by parents for information regarding their children’s health. Objective: This study aimed to develop and validate an instrument designed to assess parents' web-based health information searching behavior, the Children’s Health Internet Research, Parental Inventory (CHIRPI). Methods: A pilot survey was used to establish the instrument (21 items). CHIRPI was validated online in a second sample (372/384, 96.9% mothers; mean age 32.7 years, SD 5.8). Item analyses, an exploratory factor analysis (EFA), and correlations with parents’ perception of their children’s health-related vulnerability (Child Vulnerability Scale, CVS), parental health anxiety (modified short Health Anxiety Inventory, mSHAI), and parental cyberchondria (Cyberchondria Severity Scale, CSS-15) were calculated. A subset of participants (n=73) provided retest data after 4 weeks. CHIRPI scores (total scores and subscale scores) of parents with a chronically ill child and parents who perceived their child to be vulnerable (CVS+; CVS>10) were compared with 2×2 analyses of variances (ANOVAs) with the factors Child’s Health Status (chronically ill vs healthy) and perceived vulnerability (CVS+ vs CVS−). Results: CHIRPI’s internal consistency was standardized alpha=.89. The EFA identified three subscales: Symptom Focus (standardized alpha=.87), Implementing Advice (standardized alpha=.74) and Distress (standardized alpha=.89). The retest reliability of CHIRPI was measured as rtt=0.78. CHIRPI correlated strongly with CSS-15 (r=0.66) and mSHAI (r=0.39). The ANOVAs comparing the CHIRPI total score and the subscale scores for parents having a chronically ill child and parents perceiving their child as vulnerable revealed the main effects for perceiving one’s child as vulnerable but not for having a chronically ill child. No interactions were found. This pattern was observed for the CHIRPI total score (η2=0.053) and each subscale (Symptom Focus η2=0.012; Distress η2=0.113; and Implementing Advice η2=0.018). Conclusions: The psychometric properties of CHIRPI are excellent. Correlations with mSHAI and CSS-15 indicate its validity. CHIRPI appears to be differentially sensitive to excessive searches owing to parents perceiving their child’s health to be vulnerable rather than to higher informational needs of parents with chronically ill children. Therefore, it may help to identify parents who search excessively for web-based health information. CHIRPI (and, in particular, the Distress subscale) seems to capture a pattern of factors related to anxious health-related cognitions, emotions, and behaviors of parents, which is also applied to their children. %M 32293571 %R 10.2196/16148 %U https://www.jmir.org/2020/4/e16148 %U https://doi.org/10.2196/16148 %U http://www.ncbi.nlm.nih.gov/pubmed/32293571 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16526 %T Exploring the Factors Influencing Consumers to Voluntarily Reward Free Health Service Contributors in Online Health Communities: Empirical Study %A Zhou,Junjie %A Liu,Fang %A Zhou,Tingting %+ China Life Property & Casualty Insurance Company Limited, No 16 Jinrong Street, Beijing, China, 86 1066190179, liu-fang@chinalife-p.com.cn %K telemedicine %K health services %K social media %K reward %K social interaction %K social support %K pay-what-you-want %D 2020 %7 14.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Rewarding health knowledge and health service contributors with money is one possible approach for the sustainable provision of health knowledge and health services in online health communities (OHCs); however, the reasons why consumers voluntarily reward free health knowledge and health service contributors are still underinvestigated. Objective: This study aimed to address the abovementioned gap by exploring the factors influencing consumers’ voluntary rewarding behaviors (VRBs) toward contributors of free health services in OHCs. Methods: On the basis of prior studies and the cognitive-experiential self-theory (CEST), we incorporated two health service content–related variables (ie, informational support and emotional support) and two interpersonal factors (ie, social norm compliance and social interaction) and built a proposed model. We crawled a dataset from a Chinese OHC for mental health, coded it, extracted nine variables, and tested the model with a negative binomial model. Results: The data sample included 2148 health-related questions and 12,133 answers. The empirical results indicated that the effects of informational support (β=.168; P<.001), emotional support (β=.463; P<.001), social norm compliance (β=.510; P<.001), and social interaction (β=.281; P<.001) were significant. The moderating effects of social interaction on informational support (β=.032; P=.02) and emotional support (β=−.086; P<.001) were significant. The moderating effect of social interaction on social norm compliance (β=.014; P=.38) was insignificant. Conclusions: Informational support, emotional support, social norm compliance, and social interaction positively influence consumers to voluntarily reward free online health service contributors. Social interaction enhances the effect of informational support but weakens the effect of emotional support. This study contributes to the literature on knowledge sharing in OHCs by exploring the factors influencing consumers’ VRBs toward free online health service contributors and contributes to the CEST literature by verifying that the effects of experiential and rational systems on individual behaviors can vary while external factors change. %M 32286231 %R 10.2196/16526 %U http://www.jmir.org/2020/4/e16526/ %U https://doi.org/10.2196/16526 %U http://www.ncbi.nlm.nih.gov/pubmed/32286231 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e13369 %T Comparing Medical Term Usage Patterns of Professionals and Search Engine and Community Question Answering Service Users in Japan: Log Analysis %A Taira,Kazuya %A Murayama,Taichi %A Fujita,Sumio %A Ito,Mikiko %A Kamide,Kei %A Aramaki,Eiji %+ Department of Public Health Nursing, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan, 81 +81775482398, tairak@belle.shiga-med.ac.jp %K health knowledge %K internet %K search engine %K community question answering service %K information-seeking behavior %D 2020 %7 13.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite increasing opportunities for acquiring health information online, discussion of the specific words used in searches has been limited. Objective: The aim of this study was to clarify the medical information gap between medical professionals and the general public in Japan through health information–seeking activities on the internet. Methods: Search and posting data were analyzed from one of the most popular domestic search engines in Japan (Yahoo! JAPAN Search) and the most popular Japanese community question answering service (Yahoo! Chiebukuro). We compared the frequency of 100 clinical words appearing in the clinical case reports of medical professionals (clinical frequency) with their frequency in Yahoo! JAPAN Search (search frequency) logs and questions posted to Yahoo! Chiebukuro (question frequency). The Spearman correlation coefficient was used to quantify association patterns among the three information sources. Additionally, user information (gender and age) in the search frequency associated with each registered user was extracted. Results: Significant correlations were observed between clinical and search frequencies (r=0.29, P=.003), clinical and question frequencies (r=0.34, P=.001), and search and question frequencies (r=0.57, P<.001). Low-frequency words in clinical frequency (eg, “hypothyroidism,” “ulcerative colitis”) highly ranked in search frequency. Similarly, “pain,” “slight fever,” and “numbness” were highly ranked only in question frequency. The weighted average of ages was 34.5 (SD 2.7) years, and the weighted average of gender (man –1, woman +1) was 0.1 (SD 0.1) in search frequency. Some words were specifically extracted from the search frequency of certain age groups, including “abdominal pain” (10-20 years), “plasma cells” and “inflammatory findings” (20-30 years), “DM” (diabetes mellitus; 30-40 years), “abnormal shadow” and “inflammatory findings” (40-50 years), “hypertension” and “abnormal shadow” (50-60 years), and “lung cancer” and “gastric cancer” (60-70 years). Conclusions: Search and question frequencies showed similar tendencies, whereas search and clinical frequencies showed discrepancy. Low-clinical frequency words related to diseases such as “hypothyroidism” and “ulcerative colitis” had high search frequencies, whereas those related to symptoms such as “pain,” “slight fever,” and “numbness” had high question frequencies. Moreover, high search frequency words included designated intractable diseases such as “ulcerative colitis,” which has an incidence of less than 0.1% in the Japanese population. Therefore, it is generally worthwhile to pay attention not only to major diseases but also to minor diseases that users frequently seek information on, and more words will need to be analyzed in the future. Some characteristic words for certain age groups were observed (eg, 20-40 years: “cancer”; 40-60 years: diagnoses and diseases identified in health examinations; 60-70 years: diseases with late adulthood onset and “death”). Overall, this analysis demonstrates that medical professionals as information providers should be aware of clinical frequency, and medical information gaps between professionals and the general public should be bridged. %M 32281938 %R 10.2196/13369 %U https://www.jmir.org/2020/4/e13369 %U https://doi.org/10.2196/13369 %U http://www.ncbi.nlm.nih.gov/pubmed/32281938 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e15906 %T Online Health Information–Seeking Among Older Women With Chronic Illness: Analysis of the Women’s Health Initiative %A Sedrak,Mina S %A Soto-Perez-De-Celis,Enrique %A Nelson,Rebecca A %A Liu,Jennifer %A Waring,Molly E %A Lane,Dorothy S %A Paskett,Electra D %A Chlebowski,Rowan T %+ City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA, 91010, United States, 1 626 256 4673 ext 86635, msedrak@coh.org %K online health information–seeking %K digital health %K technology %K chronic disease %K internet %D 2020 %7 9.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Understanding how older patients with chronic illnesses use the internet to obtain health information is relevant for the design of digital interventions aimed at improving the health and well-being of adults aged 65 years and older; this cohort represents the sickest, most expensive, and fastest-growing segment of the US population. Objective: The objective of our study was to describe online health information–seeking behavior among older patients with chronic illnesses and to compare the characteristics of patients who report using the internet to obtain health information with those who do not. Methods: The study population included 72,806 women aged 65 years and older enrolled in the Women’s Health Initiative (WHI), a national cohort study, who completed a 2014 supplemental questionnaire assessing everyday technology use and internet use for researching health conditions. Comparisons were made between participants with and without a history of chronic illness and between users and nonusers of online sources for health information. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% CIs. Results: Of the total, 59% (42,887/72,806) of older women used the internet for health information. Compared with women who did not use the internet to obtain health information, those who used the internet were younger (median age: 76 vs 81 years), more likely to be non-Hispanic white (90% [38,481/42,887] vs 87% [26,017/29,919]), earned a higher income (over $US 50,000: 55% [23,410/42,887] vs 33% [9991/29,919]), achieved a higher educational level (more than high school: 87% [37,493/42,887] vs 75% [22,377/29,919]), and were more likely to live with a partner (52% [22,457/42,887] vs 36% [10,759/29,919]) (all P<.001). Women with Alzheimer disease were least likely to report online health information–seeking compared to those without the disease (OR 0.41, 95% CI 0.38-0.43). In contrast, women with a recent diagnosis of cancer, within the previous 2 years (OR 1.23, 95% CI 1.11-1.36) or 2-5 years ago (OR 1.09, 95% CI 1.00-1.19), were most likely to use the internet for health information. Conclusions: Nearly 6 in 10 older women participating in the WHI reported using the internet to obtain health information. Patients recently diagnosed with cancer are more likely to be looking for health information online, even after adjustment for age, suggesting that these patients may have a greater need for digital health resources. %M 32271152 %R 10.2196/15906 %U http://www.jmir.org/2020/4/e15906/ %U https://doi.org/10.2196/15906 %U http://www.ncbi.nlm.nih.gov/pubmed/32271152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e14979 %T Information Needs and Information-Seeking Behavior of Italian Neurologists: Exploratory Mixed Methods Study %A Demergazzi,Silvia %A Pastore,Luca %A Bassani,Giada %A Arosio,Marco %A Lonati,Caterina %+ Center for Preclinical Research, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 9 Pace Street, Milan, Italy, 39 392 691 2199, caterina.lonati@gmail.com %K information-seeking behavior %K information needs %K information sources %K medical information delivery %K neurologists %K multiple sclerosis %K migraine %D 2020 %7 8.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Current medical professions involve an extensive knowledge of the latest validated scientific data to implement disease diagnosis, therapeutic strategies, and patient care. Although clinicians can refer to a growing number and type of information sources to keep current with new scientific achievements, there are still various concerns about medical information validity, quality, and applicability into clinical practice. Novel strategies are required to identify physicians’ real-life needs with the final aim to improve modern medical information delivery. Objective: Our research used an innovative tool to collect real-time physician queries in order to investigate information needs and seeking behavior of Italian neurologists treating patients with multiple sclerosis (MS) and migraine. Methods: The study was designed as an exploratory mixed methods (ie, qualitative and quantitative) study involving 15 consecutive days of observation. A total of 50 neurologists (n=25 MS and n=25 migraine specialists) were recruited. Data were collected using an instant messaging mobile app designed for this research. At each information-seeking event, moderators triggered a computer-assisted personal interview including both semistructured interview and close-ended questions. Interactions and physician queries collected using the mobile app were coded into emerging themes by content analysis. Results: Neurologist queries were relevant to the following major themes: therapy management (36/50, 71%) and drug-related information (34/50, 67%), followed by diagnostic strategies and procedures (21/50, 42%). Quantitative analysis indicated online resources were preferentially used by clinicians (48/50, 96%) compared with offline sources (24/50, 47%). A multichannel approach, in which both online and offline sources were consulted to meet the same need, was adopted in 33% (65/198) of information-seeking events. Neurologists more likely retrieved information from online relative to offline channels (F=1.7; P=.01). MS specialists were 53% more likely to engage in one information-seeking event compared with migraine neurologists (risk ratio 1.54; 95% CI 1.16-2.05). MS specialists tended to be more interested in patient-related content than migraine clinicians (28% [7/25] vs 10% [2/25], P=.06), who conversely more likely sought information concerning therapy management (85% [21/25] vs 60% [15/25], P=.05). Compared with MS clinicians, migraine specialists had a harder time finding the required information, either looking at online or offline channels (F=12.5; P=.01) and less frequently used offline channels (30% [8/25] vs 60% [15/25] of information-seeking events, P=.02). When multiple sources needed to be consulted to retrieve an information item, a reduced satisfaction rate was observed both among migraine and MS specialists (single source vs multiple sources P=.003). Conclusions: This study provides a detailed description of real-life seeking behavior, educational needs, and information sources adopted by Italian MS and migraine neurologists. Neurologist information needs and seeking behavior reflect the specific characteristics of the specialty area in which they operate. These findings suggest identification of time- and context-specific needs of clinicians is required to design an effective medical information strategy. %M 32181742 %R 10.2196/14979 %U https://www.jmir.org/2020/4/e14979 %U https://doi.org/10.2196/14979 %U http://www.ncbi.nlm.nih.gov/pubmed/32181742 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 7 %N 1 %P e16101 %T An Internet-Based Consumer Resource for People with Low Back Pain (MyBackPain): Development and Evaluation %A Hodges,Paul William %A Setchell,Jenny %A Nielsen,Mandy %+ The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, 4072, Australia, 61 404854589, p.hodges@uq.edu.au %K back pain %K patient education %K patient internet portals %K evidence-based health care %K patient involvement %K service user involvement %D 2020 %7 31.3.2020 %9 Viewpoint %J JMIR Rehabil Assist Technol %G English %X People increasingly use the internet to obtain information about health complaints, including low back pain (LBP). LBP is the leading cause of disability internationally, and outcomes are worsening. There is an urgent need for resources that aid improvement of outcomes. There have been calls to engage consumers in the development of resources, but this has rarely been implemented. MyBackPain is a website that was developed with extensive involvement of consumers to ensure that the resource meets their needs for content and presentation. This paper aimed to describe the multistep process undertaken to develop the MyBackPain website and provide an extensive evaluation of its impact. Development of MyBackPain involved 10 steps, many of which have been published in the academic literature. These steps included consultation regarding consumer needs, evaluation of existing internet resources, identification of key messages to be reinforced, identification of frequently asked questions, consensus for content, content development (including development of algorithms to guide tailoring of the user experience), development of consumer-focused evidence-based treatment summaries, development of descriptions of health care providers, and testing. Evaluation included qualitative examination of people’s interactions with the website and its effects on their daily lives and an ongoing randomized controlled trial of impact of use of the site on people’s LBP-related health literacy, clinical outcomes, and treatment choices. It is hoped that the website can aid in the reduction of the massive burden of LBP and provide a template for the development of resources for other conditions. %M 32229467 %R 10.2196/16101 %U http://rehab.jmir.org/2020/1/e16101/ %U https://doi.org/10.2196/16101 %U http://www.ncbi.nlm.nih.gov/pubmed/32229467 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e14414 %T Sources of Health Information and Their Impacts on Medical Knowledge Perception Among the Saudi Arabian Population: Cross-Sectional Study %A Alduraywish,Shatha A %A Altamimi,Lamees A %A Aldhuwayhi,Rawan A %A AlZamil,Lama R %A Alzeghayer,Luluh Y %A Alsaleh,Futoon S %A Aldakheel,Fahad M %A Tharkar,Shabana %+ Department of Family and Community Medicine, College of Medicine, King Saud University, Alshikh Hasan Bin Abdullah Alshikh, Riyadh, 12373, Saudi Arabia, 966 1146 79860, s.alduraywish@gmail.com %K health information sources %K health perception %K medical information sources %K satisfaction %K social media %K trust %D 2020 %7 19.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Having a reliable source for health information is vital to build a strong foundation of knowledge, especially with the current revolution of the internet and social media, which raises many concerns regarding harmful effects on the health of the public. However, there are no studies on how the Saudi Arabian population seeks health information. Details about the most used and trusted sources of health information among the public will help health authorities and public awareness accounts on social media to effectively disseminate health information. Objective: To investigate the types of sources accessed by the Saudi Arabian population while seeking health information, as well as their level of trust in the sources and to assess the impact of these sources on their perception of medical knowledge and health decision-making. Methods: A cross-sectional study was conducted to meet the objectives. The study population included both men and women who were aged 16 years or more and visited primary care clinics at King Khalid University Hospital. Four hundred and thirteen participants were sampled using the simple random method, and a self-administered questionnaire was used to collect data. The data were analyzed using SPSS software (IBM Corp, Armonk, New York, USA). Results: A total of 413 participants were included in this study, and of these, 99 (24.0%) were males and 206 (49.9%) had a bachelor’s degree. Doctors were chosen as the first source of information by 87.6% (283/323) of the participants, and they were completely trusted by most of the population (326/411, 79.3%). The second most commonly used source was pharmacists (112/194, 57.7%), and they were partially trusted by 41.4% (159/384) of the participants. Internet searches, social media, and traditional medicine were not prioritized by most of the participants as the first or second source of health information. The majority of the participants did not trust information obtained from social media, and WhatsApp was the most untrusted source. Almost half of the respondents (197/413, 47.7%) acknowledged that various sources of information can often help them understand their health problems. However, the majority disagreed on substituting a doctor’s prescription with information obtained from the internet or a friend or relative. Conclusions: Although physicians were preferred and highly trusted, internet sources appeared to impact the medical knowledge of the population. The population still preferred to use internet search to obtain health information prior to a doctor’s visit. %M 32191208 %R 10.2196/14414 %U http://www.jmir.org/2020/3/e14414/ %U https://doi.org/10.2196/14414 %U http://www.ncbi.nlm.nih.gov/pubmed/32191208 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e16133 %T Attitudes of Nurses Towards Searching Online for Medical Information for Personal Health Needs: Cross-Sectional Questionnaire Study %A Zigdon,Avi %A Zigdon,Tamar %A Moran,Daniel Sender %+ Department of Health Systems Management, School of Health and Medical Sciences, Ariel University, Science Park, P O B 3, Ariel, 40700, Israel, 972 3 907 6571, aviz@ariel.ac.il %K information retrieval %K social media %K evidence-based practice %K nursing education %K eHealth %D 2020 %7 16.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Use of online clinical health care information has become part of the skill set required by medical teams. Nurses believe that information quality and availability affect nursing care and methods. However, nurses tend not to exploit professional medical databases for evidence-based medical information for their personal needs. This phenomenon has received little research attention. Objective: This study aimed to address the knowledge gap around nurses' attitudes towards searching online for medical information for their personal needs (ie, for themselves and their families) by (1) evaluating the level of exposure to medical information and the effect on attitudes towards the use of online search options, (2) assessing the effect of the choice of a primary means of searching for medical information on the attitudes towards the use of online search options, and (3) gauging the influence of sociodemographic data and health status on nurses’ attitudes towards searching online for medical information. Methods: Nurses employed in general departments in a general hospital (34/210, 16.2%), nursing home (42/200, 21.0%), and geriatric medical center (45/180, 25.0%) in Israel were invited to complete the eHealth Impact Questionnaire (alpha=.95). Questionnaires were distributed by nurses in charge of the general hospitalization wards. The data collection period was February to March 2018. The response rate was 40.3% (121/300). Results: Nurses tended to search for medical information for personal needs on social media (24/121, 19.8%) and TV (eg, health programs, health news; 23/121, 19.0%). Nurses who chose social media as their primary means of receiving general information had a positive attitude about using the online environment as a source for medical information compared to nurses who found information through other means (t119=4.44, P<.001). Nurses exposed to medical information via social media had a positive attitude towards the use of the internet to find medical information compared to nurses who were not exposed to social media (t119=3.04, P=.003). The attitudes of nurses towards the utility of online medical information for personal needs increased with better participant health status (F2,118=3.63, P=.03). However, the attitudes of participants with a chronic disease did not differ from those of healthy participants. Conclusions: Nurses in Israel are less likely to use their professional skills and knowledge to search in professional databases for evidence-based medical information for their personal needs. Instead, they prefer medical information that is easy to access and not evidence-based, such as that on social media and TV. However, these search patterns for personal use may affect their clinical role, impair quality of care, and lead to incorrect medical decisions for their patients in the health care system. Therefore, during nursing education, training for searching skills, retrieval skills, and online search techniques for evidence-based medical information is vital for evidence-based practice. %M 32175910 %R 10.2196/16133 %U http://www.jmir.org/2020/3/e16133/ %U https://doi.org/10.2196/16133 %U http://www.ncbi.nlm.nih.gov/pubmed/32175910 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e16685 %T Effects of Positive Language and Profession on Trustworthiness and Credibility in Online Health Advice: Experimental Study %A König,Lars %A Jucks,Regina %+ Department of Psychology, University of Münster, Fliednerstr 21, Münster, 48149, Germany, 49 2518339459, lars.koenig@uni-muenster.de %K health communication %K information-seeking behavior %K language %K occupations %K trust %D 2020 %7 10.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: When searching for health information, many people use the internet as their first source of information. In online health forums, for example, users post their questions and exchange health advice. In recent years, information givers from various professions have begun to use positive language (indicated by the frequent use of positively valenced adjectives) to communicate their information and persuade their audiences. Objective: The goal of the current study was to answer the following research questions: (1) How does positive language, in comparison to neutral language, influence the trustworthiness of a person arguing in an online health forum and the credibility of their health claims; (2) How does working for a university, compared to working for a lobbying organization, influence the trustworthiness of a person arguing in an online health forum and the credibility of their health claims; and (3) Do the two factors of language style and professional affiliation interact with each other to influence trustworthiness and credibility judgments? Methods: In a 2 × 2 between-subject experiment, 242 participants read a post from an online health forum and subsequently rated the trustworthiness of the forum post author and the credibility of their information. Within the post, the professional affiliation (scientist vs lobbyist) and language style (neutral vs positive) of the forum post author was varied. Results: When the forum post author used a positive language style, they were perceived as less trustworthy (high Machiavellianism [P<.001; η2p=.076], low Integrity [P=.001; η2p=.045], and low Benevolence [P=.02; η2p=.025]) and their information was perceived as less credible (low Message Credibility [P=.001; η2p=.045]). The professional affiliation of the forum post author did not influence their trustworthiness or the credibility of their information. Conclusions: When searching for health information, information seekers evaluate the language style of forum posts to decide whether forum post authors are trustworthy and their information is credible. %M 32154786 %R 10.2196/16685 %U http://www.jmir.org/2020/3/e16685/ %U https://doi.org/10.2196/16685 %U http://www.ncbi.nlm.nih.gov/pubmed/32154786 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15065 %T Assessment of the Frequency of Online Searches for Symptoms Before Diagnosis: Analysis of Archival Data %A Hochberg,Irit %A Allon,Raviv %A Yom-Tov,Elad %+ Microsoft Research, 13 Shenkar St, Herzeliya, 46733, Israel, 972 747111359, eladyt@yahoo.com %K search engines %K diagnosis %K screening %D 2020 %7 6.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Surveys suggest that a large proportion of people use the internet to search for information on medical symptoms they experience and that around one-third of the people in the United States self-diagnose using online information. However, surveys are known to be biased, and the true rates at which people search for information on their medical symptoms before receiving a formal medical diagnosis are unknown. Objective: This study aimed to estimate the rate at which people search for information on their medical symptoms before receiving a formal medical diagnosis by a health professional. Methods: We collected queries made on a general-purpose internet search engine by people in the United States who self-identified their diagnosis from 1 of 20 medical conditions. We focused on conditions that have evident symptoms and are neither screened systematically nor a part of usual medical care. Thus, they are generally diagnosed after the investigation of specific symptoms. We evaluated how many of these people queried for symptoms associated with their medical condition before their formal diagnosis. In addition, we used a survey questionnaire to assess the familiarity of laypeople with the symptoms associated with these conditions. Results: On average, 15.49% (1792/12,367, SD 8.4%) of people queried about symptoms associated with their medical condition before receiving a medical diagnosis. A longer duration between the first query for a symptom and the corresponding diagnosis was correlated with an increased likelihood of people querying about those symptoms (rho=0.6; P=.005); similarly, unfamiliarity with the association between a condition and its symptom was correlated with an increased likelihood of people querying about those symptoms (rho=−0.47; P=.08). In addition, worrying symptoms were 14% more likely to be queried about. Conclusions: Our results indicate that there is large variability in the percentage of people who query the internet for their symptoms before a formal medical diagnosis is made. This finding has important implications for systems that attempt to screen for medical conditions. %M 32141835 %R 10.2196/15065 %U https://www.jmir.org/2020/3/e15065 %U https://doi.org/10.2196/15065 %U http://www.ncbi.nlm.nih.gov/pubmed/32141835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e13120 %T The Association Between Health Information Seeking on the Internet and Physician Visits (The Seventh Tromsø Study - Part 4): Population-Based Questionnaire Study %A Yigzaw,Kassaye Yitbarek %A Wynn,Rolf %A Marco-Ruiz,Luis %A Budrionis,Andrius %A Oyeyemi,Sunday Oluwafemi %A Fagerlund,Asbjørn Johansen %A Bellika,Johan Gustav %+ Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050 Langnes, Tromsø, 9037, Norway, 47 95748049, johan.gustav.bellika@ehealthresearch.no %K eHealth %K internet %K health care service %K physician visit %K Tromsø study %K health information seeking %K Web search engine %K health app %K social media %K video search engine %D 2020 %7 5.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet is being widely used for seeking health information. However, there is no consensus on the association between health information seeking on the internet and the use of health care services. Objective: We examined the association between health information seeking via the internet and physician visits. In addition, we investigated the association between online health information seeking and the decisions to visit and not to visit a physician. Methods: We used the cross-sectional electronic health (eHealth) data of 18,197 participants from the seventh survey of the Tromsø Study (Tromsø 7). The participants were aged ≥40 years and living in Tromsø, Norway. We used logistic regression models to examine the association between online health information seeking and physician visits, the decision to visit a physician, and the decision not to visit a physician, with adjustment for the demographic status, socioeconomic status, and health status of the participants. Results: The use of Web search engines was associated with a physician visit. However, the association was moderated by age, and the OR decreased as age increased. The ORs for the use of Web search engines were 1.99 (95% CI 1.94-2.02) and 1.07 (95% CI 1.03-1.12) at ages 40 and 80 years, respectively. The decision to visit a physician was associated with the use of Web search engines (OR 2.95, 95% CI 2.03-4.46), video search engines (OR 1.43, 95% CI 1.21-1.70), and health apps (OR 1.26, 95% CI 1.13-1.42). The association between social media use and the decision to visit a physician was moderated by gender. Women who used social media had 1.42 (95% CI 1.31-1.55) times higher odds of deciding to visit a physician, whereas the decision to visit a physician was not different between men who used social media and those who did not use social media. Conversely, the decision not to visit a physician was associated with the use of Web search engines (OR 2.78, 95% CI 1.92-4.18), video search engines (OR 1.27, 95% CI 1.07-1.51), social media (OR 1.28, 95% CI 1.10-1.49), and health apps (OR 1.20, 95% CI 1.07-1.35). Conclusions: Health information found on the internet was positively associated with both the decision to visit a physician and the decision not to visit a physician. However, the association of health information seeking with the decision to visit a physician was slightly stronger than the association with the decision not to visit a physician. This could imply that the use of eHealth services is associated with a resultant increase in physician visits. In summary, our findings suggest that the internet serves as a supplement to health care services rather than as a replacement. %M 32134387 %R 10.2196/13120 %U https://www.jmir.org/2020/3/e13120 %U https://doi.org/10.2196/13120 %U http://www.ncbi.nlm.nih.gov/pubmed/32134387 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e14095 %T Medical Help-Seeking Strategies for Perinatal Women With Obstetric and Mental Health Problems and Changes in Medical Decision Making Based on Online Health Information: Path Analysis %A Chung,Kyungmi %A Cho,Hee Young %A Kim,Young Ran %A Jhung,Kyungun %A Koo,Hwa Seon %A Park,Jin Young %+ Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, , Republic of Korea, 82 2 2228 0972, empathy@yuhs.ac %K perinatal care %K obstetrics %K mental health %K information seeking behavior %K help-seeking behavior %K self efficacy %K health literacy %K consultation %K decision making %K internet %D 2020 %7 4.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have revealed that most pregnant women rarely discuss informal information found on the internet with health professionals and have frequently expressed concerns for medical experts’ reactions to the online information they shared, as well as the lack of time to consult the medical experts in general. To date, little information is available on the effect of individual differences in utilizing medical help-seeking strategies on their medical decisions during the perinatal period. Objective: The objectives of this study were (1) to determine associations among perinatal women’s medical help-seeking strategies, changes in medical decision making, and online health information utilization with a focus on the mediating effect of self-efficacy in perinatal health literacy on the intent to consult health professionals, and (2) to clarify these associations in perinatal women with two different medical problems: obstetric and mental health. Methods: A total of 164 perinatal women aged 24 to 47 years (mean 34.64, SD 3.80) repeatedly completed the Problem Solving in Medicine and Online Health Information Utilization questionnaires to examine the moderating effect of two types of medical problems on their decision-making processes. To validate the hypothesized relationships in the proposed conceptual model encompassing obstetric and mental health problem-solving models, path analyses were performed. Results: This study found that some perinatal women, who use an online informal medical help-seeking (OIMH) strategy, would be more likely to change their medical decisions based only on internet-based information without consulting health professionals (P<.001), compared to other women using different medical help-seeking strategies. Particularly, this concern is significantly prevalent when encountering obstetric problems during the perinatal period (obstetric problem-solving: P<.001; mental health problem-solving: P=.02). Furthermore, perinatal women with mental health issues using the OIMH strategy showed a significant difference in intent to consult health professionals based on online health information when the medical problem they had to solve was different (obstetric problem-solving: P=.94; mental health problem-solving: P=.003). Conclusions: Despite the positive mediating effects of perinatal women’s enhanced health literacy on the intent to discuss personal medical issues with health professionals based on online health information, the strategy used is of fundamental importance for understanding their help-seeking and decision-making processes during the perinatal period. Beyond a short consultation to steer patients quickly and authoritatively towards an obstetric doctor’s choice of action, it is recommended in this study that obstetricians attempt to provide their patients with needed context for the information found online. To fully explain this information with an open mind, they should actively develop or support information and communications technology (ICT)-based health information services. %M 32130139 %R 10.2196/14095 %U https://www.jmir.org/2020/3/e14095 %U https://doi.org/10.2196/14095 %U http://www.ncbi.nlm.nih.gov/pubmed/32130139 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 3 %P e16279 %T Undergraduate Medical Students’ Search for Health Information Online: Explanatory Cross-Sectional Study %A Loda,Teresa %A Erschens,Rebecca %A Junne,Florian %A Stengel,Andreas %A Zipfel,Stephan %A Herrmann-Werner,Anne %+ Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr 5, Tuebingen, 72076, Germany, 49 07071 ext 2986719, rebecca.erschens@med.uni-tuebingen.de %K digital health literacy %K medical education %K evidence-based online information %K digital native %K trustworthy webpages %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Previous research shows that being a “digital native” or growing up in a digital environment does not necessarily lead to increased digital competencies, such as digital health literacy or evaluation of webpage quality. Objective: This study showed how medical students searched for health information online, specifically the recommended testing for histamine intolerance, by comparing the use of various search engines (Google, Medisuch, and a website of the student’s choice) to find out more about search strategies in future health professionals. As Medisuch presents a qualitatively better search engine, we assumed that medical students using this search engine might find valid information faster on more reliable webpages, and might recommend the correct diagnostic steps for histamine intolerance to their patients more often than students using a generic search engine like Google. Methods: Medical students in their third year of study were asked to find the relevant diagnostic steps of histamine intolerance online. They were randomly assigned to use one search engine: Google, their personal choice, or Medisuch. Their process of seeking information online was video recorded. Results: In total, 140 medical students participated in this study. The total number of webpages found did not differ among the groups (P=.52). Students using Medisuch (P=.02) correctly identified the elimination diet as a relevant diagnostic step more frequently. The provocation test was reported by almost half of the students independent of the search engine used. In general, medical students commonly identified trustworthy webpages in all three groups (Google: 36/44, 82%; free choice: 31/36; 86%; and Medisuch: 35/45, 78%). Conclusions: The results indicate that medical students were able to find trustworthy health-related information online independent of the search engine used. Medical students that are digital natives seem to have proper internet skills and a knowledge of how to use them. They entered specific medical terms (evidence-based diagnostic steps) or names of reliable webpages (DocCheck) in the search engines to gain correct information. However, it remains to be seen if this behavior can be called true “digital literacy”. %M 32130146 %R 10.2196/16279 %U https://medinform.jmir.org/2020/3/e16279 %U https://doi.org/10.2196/16279 %U http://www.ncbi.nlm.nih.gov/pubmed/32130146 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e15148 %T Prevalence and Outcomes of Web-Based Health Information Seeking for Acute Symptoms: Cross-Sectional Study %A Aoun,Lydia %A Lakkis,Najla %A Antoun,Jumana %+ Department of Family Medicine, American University of Beirut, Beirut, Lebanon, 961 1350000 ext 3049, ja46@aub.edu.lb %K internet %K health information %K acute symptoms %K acute disease %D 2020 %7 10.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The literature indicates that Web-based health information seeking is mostly used for seeking information on well-established diseases. However, only a few studies report health information seeking in the absence of a doctor’s visit and in the context of acute symptoms. Objective: This survey aimed to estimate the prevalence of Web-based health information seeking for acute symptoms and the impact of such information on symptom management and health service utilization. Methods: This was a cross-sectional study of a convenience sample of 287 Lebanese adults (with a response rate of 18.5% [54/291]) conducted between December 2016 and June 2017. The survey was answered by participants online or through phone-based interviews. Results: A total of 64.3% of the participants (178/277) reported checking the internet for health information when they had an acute symptom. The rate of those who sought to use Web-based health information first when experiencing acute symptom(s) in the past 12 months was 19.2% (25/130). In addition, 50% (9/18) visited the doctor because of the obtained information, and the rest self-medicated or sought a pharmacist’s advice; the majority (18/24, 75%) improved within 3-4 days. Conclusions: Higher education level and trust in Web-based medical information were two major predictors of Web-based health information seeking for acute symptoms. Seeking Web-based health information first for acute symptoms is common and may lead to self-management by avoiding a visit to the physician. Physicians should encourage their patients to discuss Web-based health information and guide them toward trusted online websites. %M 31922490 %R 10.2196/15148 %U https://www.jmir.org/2020/1/e15148 %U https://doi.org/10.2196/15148 %U http://www.ncbi.nlm.nih.gov/pubmed/31922490 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e15924 %T Exploring the Views of Osteogenesis Imperfecta Caregivers on Internet-Based Technologies: Qualitative Descriptive Study %A Castro,Aimee R %A Chougui,Khadidja %A Bilodeau,Claudette %A Tsimicalis,Argerie %+ Shriners Hospitals for Children-Canada, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada, 1 (514) 3988142, argerie.tsimicalis@mcgill.ca %K smartphone %K caregivers %K pediatrics %K rare diseases %K telemedicine %K quality improvement %K social media %K chronic disease %K osteogenesis imperfecta %D 2019 %7 18.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Osteogenesis imperfecta (OI) is a rare genetic condition that can lead to frequent debilitating bone fractures. Family caregivers of children with OI face unique challenges in providing care, which may include limited access to information about the condition, feelings of distress, and experiences of social isolation. Internet-based technologies (IBTs) have been useful for supporting other types of caregivers. However, the views of OI caregivers on IBTs have not been explored. Objective: This study aimed to explore the views of OI caregivers on the uses of IBTs to support them in caring for their children with OI. Methods: A qualitative descriptive study was conducted. Caregivers of children with OI were recruited at a pediatric hospital in Montreal, Canada. Interviews were used to explore each caregiver’s views on the applicability of IBTs in supporting their caregiving needs. The interviews were transcribed verbatim and thematically analyzed. Results: A total of 18 caregivers participated. The caregivers shared that IBTs were useful for facilitating the following activities: daily activities of caregiving (such as providing physical care, supporting relationships, supporting self-care and hope, and managing the logistics of caregiving), OI medical information seeking, and OI social networking. However, they also revealed concerns about the health consequences of IBT use and the quality of IBT content. Concerns regarding IBTs varied somewhat with caregivers’ geographies. Caregivers offered suggestions and strategies for how IBTs can be optimized for caregiving. Conclusions: Family caregivers of children with OI face unique challenges in providing care, which may include lacking access to information about the rare condition and feeling socially isolated. OI caregivers use IBTs to overcome some of these challenges and to support their specific caregiving needs. These findings contribute to the paucity of knowledge by offering varied IBT strategies to support caregiving activities, which may be beneficial for other caregivers. Participants’ suggestions for IBT services can inform the development of new resources for OI caregivers and potentially for other caregivers of children living with rare conditions. %M 31850851 %R 10.2196/15924 %U http://www.jmir.org/2019/12/e15924/ %U https://doi.org/10.2196/15924 %U http://www.ncbi.nlm.nih.gov/pubmed/31850851 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e15132 %T Searching the Internet for Infertility Information: A Survey of Patient Needs and Preferences %A Brochu,Felicia %A Robins,Stephanie %A Miner,Skye A %A Grunberg,Paul H %A Chan,Peter %A Lo,Kirk %A Holzer,Hananel E G %A Mahutte,Neal %A Ouhilal,Sophia %A Tulandi,Togas %A Zelkowitz,Phyllis %+ Department of Psychiatry, Jewish General Hospital, 4333 Côte-Sainte-Catherine Road, Montreal, QC, H3T 1E4, Canada, 1 5143408222 ext 25258, phyllis.zelkowitz@mcgill.ca %K infertility %K internet %K consumer health information %K patient satisfaction %K stress, psychological %D 2019 %7 12.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the complexity of infertility diagnoses and treatments and the convenience of the internet for finding health-related information, people undergoing infertility treatments often use Web-based resources to obtain infertility information and support. However, little is known about the types of information and support resources infertility patients search for on the internet and whether these resources meet their needs. Objective: The aims of this study were to (1) examine what individual factors, namely, demographic characteristics and distress, are associated with searching the internet for different types of infertility-related information and support resources and (2) determine whether Web-based resources meet the needs of patients. Methods: Men and women seeking infertility care responded to a survey assessing use of Web-based resources for accessing infertility-related information and support. The survey further assessed satisfaction with Web-based resources as well as perceived stress and depressive symptomatology. Results: A total of 567 participants, including 254 men and 313 women, completed the survey. Most participants (490/558, 87.8%) had searched the internet for infertility information and support. Searchers were more likely to be women (P<.001), highly educated (P=.04), long-term patients (P=.03), and more distressed (P=.04). Causes of infertility, treatment options, and scientific literature about infertility were the three most frequently searched topics, whereas ways to discuss treatment with family and friends as well as surrogacy and ways to find peer support were the three least searched topics. Of those who searched the internet, 70.9% (346/488) indicated that their needs were met by Web-based information, whereas 29.1% (142/488) said that their needs were not met. Having unmet needs was related to greater levels of perceived stress (P=.005) and depressive symptomatology (P=.03). Conclusions: This study provides evidence for the important role of the internet in accessing infertility information and support and for the ability of Web-based resources to meet patients’ needs. However, although distressed patients reported particularly high rates of searching, their needs were not always met, suggesting that they may benefit from alternative sources of information and support or guidance from health care providers when searching the internet. %M 31829963 %R 10.2196/15132 %U https://www.jmir.org/2019/12/e15132 %U https://doi.org/10.2196/15132 %U http://www.ncbi.nlm.nih.gov/pubmed/31829963 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e13694 %T Pregnancy-Related Information Seeking and Sharing in the Social Media Era Among Expectant Mothers: Qualitative Study %A Zhu,Chengyan %A Zeng,Runxi %A Zhang,Wei %A Evans,Richard %A He,Rongrong %+ Smart Health Institute, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 13397110378, weizhanghust@hust.edu.cn %K pregnant women %K social media %K information seeking %K consumer health information %K China %D 2019 %7 4.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has become the most popular communication tool used by Chinese citizens, including expectant mothers. An increasing number of women have adopted various forms of social media channels, such as interactive websites, instant messaging, and mobile apps, to solve problems and obtain answers to queries during pregnancy. Although the use of the internet by pregnant women has been studied extensively worldwide, limited research exists that explores the changing social media usage habits in China, where the 1 child policy ended in 2015. Objective: This study aimed to (1) present the status quo of pregnancy-related information seeking and sharing via social media among Chinese expectant mothers, (2) reveal the impact of social media usage, and (3) shed light on pregnancy-related health services delivered via social media channels. Methods: A qualitative approach was employed to examine social media usage and its consequences on pregnant women. A total of 20 women who had conceived and were at various stages of pregnancy were interviewed from July 20 to August 10, 2017. Thematic analysis was conducted on the collected data to identify patterns in usage. Results: Overall, 80% (16/20) of participants were aged in their 20s (mean 28.5 years [SD 4.3]). All had used social media for pregnancy-related purposes. For the seeking behavior, 18 codes were merged into 4 themes, namely, gravida, fetus, delivery, and the postpartum period; whereas for sharing behaviors, 10 codes were merged into 4 themes, namely, gravida, fetus, delivery, and caretaker. Lurking, small group sharing, bad news avoidance, and cross-checking were identified as the preferred patterns for using social media. Overall, 95% (19/20) of participants reported a positive mental impact from using social media during their pregnancy. Conclusions: It is indisputable that social media has played an increasingly important role in supporting expectant mothers in China. The specific seeking and sharing patterns identified in this study indicate that the general quality of pregnancy-related information on social media, as well as Chinese culture toward pregnancy, is improving. The new themes that merge in pregnancy-related social media use represent a shift toward safe pregnancy and the promotion of a more enjoyable pregnancy. Future prenatal care should provide further information on services related to being comfortable during pregnancy and reducing the inequality of social media–based services caused by the digital divide. %M 31799939 %R 10.2196/13694 %U https://www.jmir.org/2019/12/e13694 %U https://doi.org/10.2196/13694 %U http://www.ncbi.nlm.nih.gov/pubmed/31799939 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e17045 %T Gimme My Damn Data (and Let Patients Help!): The #GimmeMyDamnData Manifesto %A deBronkart,Dave %A Eysenbach,Gunther %+ JMIR Publications, 130 Queens Quay E, Ste. 1100, Toronto, ON, Canada, 1 416 583 2040, editor@jmir.org %K data %K participatory medicine %K ehealth %D 2019 %7 22.11.2019 %9 Discussion Paper %J J Med Internet Res %G English %X Ten years ago, in 2009, “e-Patient Dave” deBronkart delivered an influential keynote speech at the Medicine 2.0 conference in Toronto, organized by the Journal of Medical Internet Research’s (JMIR’s) editor-in-chief Gunther Eysenbach, who themed the conference around the topics of participation, openness, collaboration, apomediation, and social networking to improve health care for the 21st century—with patient participation being a major component. Many see this as a defining event within the participatory medicine movement, perhaps the beginning of a social movement, similar to the women’s rights movement, with the title of Dave’s keynote “Gimme my damn data” becoming a rallying cry and hashtag for patients demanding more access to their electronic health records. On the occasion of the 20th anniversary of JMIR (and 10 years after the keynote), we are celebrating the impact of the keynote for the participatory medicine movement and #gimmemydamndata (also #GMDD) by publishing the transcript of these initial conversations as a manifesto of patients’ rights to access their data and their right to save their lives. %M 31755873 %R 10.2196/17045 %U http://www.jmir.org/2019/11/e17045/ %U https://doi.org/10.2196/17045 %U http://www.ncbi.nlm.nih.gov/pubmed/31755873 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14241 %T Health-Related Internet Use Among Men With Prostate Cancer in Canada: Cancer Registry Survey Study %A Bender,Jacqueline L %A Feldman-Stewart,Deb %A Tong,Christine %A Lee,Karen %A Brundage,Michael %A Pai,Howard %A Robinson,John %A Panzarella,Tony %+ ELLICSR Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Munk Building, B PMB 130, 585 University Avenue, Toronto, ON, M5G 2C4, Canada, 1 416 581 8606, jackie.bender@uhnresearch.ca %K prostate cancer %K internet %K health decision making %K digital divide %D 2019 %7 19.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: After a prostate cancer diagnosis, men want information about their disease and treatment options. The internet offers a convenient means to deliver health information to patients with prostate cancer. However, there are concerns about the use of the internet among this largely senior population. Objective: This study aimed to determine the patterns and factors associated with the use of the internet as a source of health information among Canadian men with prostate cancer and the features and information required in a website. Methods: Population surveys were conducted in four Canadian provinces (British Columbia, Alberta, Saskatchewan, and Ontario) in 2014-2015. Data analyses included descriptive, bivariable, and multivariable analyses. The Pearson Chi-square and univariable regression were used to examine associations between independent variables and health-related internet use. Correlates of health-related internet use were analyzed using multivariable logistic regression. Results: A total of 1362 patients responded across the four provinces. The mean age of respondents was 69 years (SD 8.2). In addition, 82% (n=1071) were internet users and 71% (n=910) used the internet daily. Further, 65% (n=784) used the internet as a source of prostate cancer information, and 40% (n=521) were confident about using information obtained from the internet to make health decisions. Men who used the internet to obtain prostate cancer information were more likely to be active information seekers (odds ratio [OR]: 4.5, 95% CI 2.6-7.8), be confident using information from the internet to make health decisions (OR: 3.6, 95% CI 2.3-5.7), have broadband internet access (OR: 1.8, 95% CI 1.2-2.7), and have more unmet supportive care needs (OR: 1.05, 95% CI 1.0-1.1). Top features wanted in a website, reported by more than 50% of respondents, were a library of resources (n=893, 65.6%), tools to support treatment decision making (n=815, 59.8%), and tools to help navigate the prostate cancer journey (n=698, 51.2%). Top three topics of information wanted in such a website were treatment options (n=916, 67.3%), disease progression (n=904, 66.4%), and management of side effects (n=858, 63%). Conclusions: Over two-thirds of Canadian patients with prostate cancer surveyed use the internet as a source of health information about prostate cancer, but over half did not feel confident using information from the internet to make health decisions. Being an active information seeker, having confidence in using information from the internet to make health decisions, having broadband internet, and having more unmet supportive care needs were significantly associated with health-related internet use. Future work should examine electronic health literacy interventions as a means to boost men’s confidence in using information from the internet and design websites that include information and features that help men navigate the prostate cancer journey and support treatment decision making and management of side effects. %M 31742561 %R 10.2196/14241 %U http://www.jmir.org/2019/11/e14241/ %U https://doi.org/10.2196/14241 %U http://www.ncbi.nlm.nih.gov/pubmed/31742561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e13873 %T Young People’s Online Help-Seeking and Mental Health Difficulties: Systematic Narrative Review %A Pretorius,Claudette %A Chambers,Derek %A Coyle,David %+ School of Computer Science, University College Dublin, Belfield, Dublin, Ireland, 353 017162818, claudette.pretorius@ucdconnect.ie %K internet %K help-seeking behavior %K youth %K mental health %K online behavior %K self-determination theory %K systematic review %D 2019 %7 19.11.2019 %9 Review %J J Med Internet Res %G English %X Background: Young people frequently make use of the internet as part of their day-to-day activities, and this has extended to their help-seeking behavior. Offline help-seeking is known to be impeded by a number of barriers including stigma and a preference for self-reliance. Online help-seeking may offer an additional domain where young people can seek help for mental health difficulties without being encumbered by these same barriers. Objective: The objective of this systematic literature review was to examine young peoples’ online help-seeking behaviors for mental health concerns. It aimed to summarize young peoples’ experiences and identify benefits and limitations of online help-seeking for this age group. It also examined the theoretical perspectives that have been applied to understand online help-seeking. Methods: A systematic review of peer-reviewed research papers from the following major electronic databases was conducted: PsycINFO, Cumulative Index of Nursing and Allied Health Literature, PubMed, Cochrane Library, Association for Computing Machinery Digital Library, and Institute of Electrical and Electronics Engineers Xplore. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The search was conducted in August 2017. The narrative synthesis approach to reviews was used to analyze the existing evidence to answer the review questions. Results: Overall, 28 studies were included. The most common method of data collection was through the use of surveys. Study quality was moderate to strong. Text-based query via an internet search engine was the most commonly identified help-seeking approach. Social media, government or charity websites, live chat, instant messaging, and online communities were also used. Key benefits included anonymity and privacy, immediacy, ease of access, inclusivity, the ability to connect with others and share experiences, and a greater sense of control over the help-seeking journey. Online help-seeking has the potential to meet the needs of those with a preference for self-reliance or act as a gateway to further help-seeking. Barriers to help-seeking included a lack of mental health literacy, concerns about privacy and confidentiality, and uncertainty about the trustworthiness of online resources. Until now, there has been limited development and use of theoretical models to guide research on online help-seeking. Conclusions: Approaches to improving help-seeking by young people should consider the role of the internet and online resources as an adjunct to offline help-seeking. This review identifies opportunities and challenges in this space. It highlights the limited use of theoretical frameworks to help conceptualize online help-seeking. Self-determination theory and the help-seeking model provide promising starting points for the development of online help-seeking theories. This review discusses the use of these theories to conceptualize online help-seeking and identify key motivations and tensions that may arise when young people seek help online. %M 31742562 %R 10.2196/13873 %U http://www.jmir.org/2019/11/e13873/ %U https://doi.org/10.2196/13873 %U http://www.ncbi.nlm.nih.gov/pubmed/31742562 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14554 %T Associations Between Characteristics of Web-Based Diabetes News and Readers’ Sentiments: Observational Study in the Netherlands %A Vehof,Hans %A Heerdink,Eibert %A Sanders,José %A Das,Enny %+ Research Group Process Innovations in Pharmaceutical Care, HU University of Applied Sciences, Heidelberglaan 7, Utrecht, 3584 CS, Netherlands, 31 625098999, hans.vehof@hu.nl %K medical journalism %K diabetes mellitus %K information seeking behaviors %K news %K diffusion of innovation %D 2019 %7 13.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Although experts agree that Web-based health information often contains exaggeration and misrepresentation of science, it is not yet known how this information affects the readers’ sentiments. Objective: This study aimed to investigate whether specific aspects of Web-based diabetes research news are associated with positive or negative sentiments in readers. Methods: A retrospective observational study of the comments on diabetes research news posted on Facebook pages was conducted as a function of the innovations’ developmental phase, the intended treatment effect, and the use of strong language to intensify the news messages (superlatives). Data for the investigation were drawn from the diabetes research news posted between January 2014 and January 2018 on the two largest Dutch Facebook pages on diabetes and the corresponding reader comments. By manually coding these Facebook user comments, three binary outcome variables were created, reflecting the presence of a positive sentiment, the presence of a negative sentiment, and the presence of a statement expressing hopefulness. Results: Facebook users made a total of 3710 comments on 173 diabetes research news posts that were eligible for further analysis. Facebook user comments on posts about diabetes prevention (odds ratio [OR] 0.55, 95% CI 0.37-0.84), improved blood glucose regulation (OR 0.68, 95% CI 0.56-0.84), and symptom relief (OR 0.31, 95% CI 0.21-0.44) were associated with less positive sentiments as compared with potential diabetes cures. Furthermore, comments on innovations supported by preclinical evidence in animals were associated with more positive sentiments (OR 1.46, 95% CI 1.07-1.99) and statements expressing hope (OR 1.47, 95% CI 1.01-2.14), when compared with innovations that have evidence from large human trials. This study found no evidence for the associations between language intensification of the news posts and the readers’ sentiments. Conclusions: Our finding that the attitudes toward diabetes research news on Facebook are most positive when clinical efficacy is not (or not yet) proven in large patient trials suggests that news authors and editors, as well as medical professionals, must exercise caution when acting as a conduit for diabetes research news. %M 31719025 %R 10.2196/14554 %U https://www.jmir.org/2019/11/e14554 %U https://doi.org/10.2196/14554 %U http://www.ncbi.nlm.nih.gov/pubmed/31719025 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e12278 %T Patients’ Use of the Internet to Find Reliable Medical Information About Minor Ailments: Vignette-Based Experimental Study %A Kwakernaak,Joyce %A Eekhof,Just A H %A De Waal,Margot W M %A Barenbrug,Elisabeth A M %A Chavannes,Niels H %+ Department Public Health & Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden, 2300RC, Netherlands, 31 715268414, j.a.h.eekhof@lumc.nl %K internet %K information seeking behaviour %K consumer health information %K diagnosis %K humans %K adult %D 2019 %7 11.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about the exact process of how patients search for medical information on the internet and what they retrieve. There is especially a paucity of literature on browsing for information on minor ailments, a term used for harmless diseases that are very common in the general population and thus have a significant impact on health care. Objective: This vignette-based experimental study aimed to explore what kind of Web-based search strategies are applied and how search strategies, demographic characteristics, and the quality of the visited websites relate to finding the right diagnosis. Additional goals were to describe how searching on the Web influences one’s perception of the severity of the potential diagnosis and whether or not the participants would discuss the information they found on the internet with their doctors. Methods: Out of 1372 survey participants, 355 were randomly sampled, and 155 of them were recruited and assigned to one of four clinical scenarios. Each search term they used was classified as one of three search strategies: (1) hypothesis testing, (2) narrowing within the general hypothesis area, and (3) symptom exploration. The quality of the websites used was determined by using the DISCERN instrument. To compare the diagnostic accuracy of the participants before and after the internet search, a McNemar test was used. Chi-square tests were used to describe which factors are related to the chosen search strategy. A multivariate binary logistic regression model was constructed to predict which factors are related to finding a sound diagnosis after searching the internet for health information. Results: Most participants (65.8%, 102/155) used the symptom exploration strategy. However, this depends on the assigned scenario (P<.001) and the self-estimated severity score of the symptoms before the internet search (P=.001). A significant relation was found between choosing an accurate diagnosis and age (odds ratio [OR] 0.94, 95% CI 0.90 to 0.98) and the clinical scenario, as well as the use of high-quality websites (OR 7.49, 95% CI 1.85 to 30.26). Browsing the internet did not lead to a statistically significant change in participants’ beliefs about the severity of the condition (McNemar test, P=.85). Most participants (65%) shared their retrieved information with their physician and most of them (75%) received a positive response. Conclusions: Our findings suggest that most patients use a symptom-based approach; however, if patients expect the potential diagnosis to be severe, they tend to use a hypothesis verification strategy more often and are therefore prone to certain forms of bias. In addition, self-diagnosing accuracy is related to younger age, the symptom scenario, and the use of high-quality websites. We should find ways to guide patients toward search strategies and websites that may more likely lead to accurate decision making. %M 31710304 %R 10.2196/12278 %U http://www.jmir.org/2019/11/e12278/ %U https://doi.org/10.2196/12278 %U http://www.ncbi.nlm.nih.gov/pubmed/31710304 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14327 %T Web-Based Health Information Seeking Among Students at Kuwait University: Cross-Sectional Survey Study %A Ashkanani,Hasan %A Asery,Rabab %A Bokubar,Fajer %A AlAli,Noor %A Mubarak,Shahad %A Buabbas,Ali %A Almajran,Abdullah %+ Faculty of Medicine, Kuwait University, Block 4, Fourth Ring Road, Health Sciences Center, Jabriyah, Kuwait, 965 246 36559, hasanashkanani@hotmail.com %K Kuwait %K online %K health care %D 2019 %7 31.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Owing to the revolution in technology, the internet has become an important aspect of people’s lives. Modern technology is enabling people from diverse educational backgrounds to use the internet for several purposes, one of which is health information seeking. Recently, Web-based health information has become more popular among patients all over the world and among the general public. Objective: This study aimed to investigate the use of Web-based health resources among undergraduate students from different faculties at Kuwait University. Methods: The study employed a cross-sectional design with students selected from 8 faculties of Kuwait University, 4 faculties of Literature and 4 faculties of Science. Data were collected using structured questionnaires, and analysis was done using a chi-square test and binary logistic regression to determine the factors associated with seeking health information on the Web. Results: The sample size obtained was 1132 with a response rate of 90.27% (1132/1254). Overall, the prevalence of students seeking Web-based health information was 92.66%. (1049/1132) The most significant factors associated with seeking health information on the Web were age, gender, faculty, year of study, primary source of internet, and level of experience with internet use. In total, 90.0% (325/361) of students who were aged older than 21 years used Web-based health information compared with 82.8% (275/332) of those who were aged 18 years. In addition, female students showed a higher prevalence (829/934, 88.8%) of Web-based health information seeking than males (210/270, 77.8%). Students who majored in faculties of Science were more likely to seek health information than those who majored in faculties of Literature. All the differences found in the study were statistically significant (P<.05). Conclusions: The study concluded that many people use the internet for seeking health information. Sociodemographic factors have a significant association with Web-based health information seeking. Therefore, doctors must educate the public about the health information websites that can be trusted. %M 31473592 %R 10.2196/14327 %U http://formative.jmir.org/2019/4/e14327/ %U https://doi.org/10.2196/14327 %U http://www.ncbi.nlm.nih.gov/pubmed/31473592 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e13240 %T Examining the Interaction Between Medical Information Seeking Online and Understanding: Exploratory Study %A Kobayashi,Rei %A Ishizaki,Masato %+ Interfaculty Initiative in Information Studies, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 5925, rei-kobayashi@hotmail.co.jp %K consumer health informatics %K information-seeking behavior %K internet access %K health communication %K health literacy %D 2019 %7 24.09.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Online information seeking on medical topics by patients can have beneficial effects by helping them decide on treatment options and fostering better relationships with doctors. The quality of websites and processes of seeking information online have mostly been studied, with a focus on the accuracy and reliability of websites; however, few studies have examined the relationship between other aspects of quality and the processes of seeking medical information online. Objective: This exploratory study aimed to shed light on the quality of websites used for information seeking from the perspective of understanding medical information in combination with seeking it online. Methods: The study participants were 15 Japanese university students with no problem using the internet. A questionnaire survey about health literacy (47 items on a 4-point Likert scale) and information navigation skills on the internet (8 items on a 5-point Likert scale) was conducted before participants engaged in online information seeking and qualitative interviews. The students searched for information on a disease and its treatment. The websites viewed were gathered from search behavior recorded by software and browser logs. Follow-up interviews were conducted to elicit explanations from the participants about the assignments and their views of online information seeking. The explanations were evaluated by 55 health care professionals on a 3-point Likert scale and then assessed based on their comments and the participant interviews. Results: The mean age of the participants was 20.6 years (median 21; SD 1.06). All participants were able to access reliable websites with information relevant to the assignments. The mean ratings of the students’ explanations were 108.6 (median 109; range=83-134) for the disease and 105.6 (median 104; range=87-117) for its treatment. The inter-rater reliability were 0.84 (95% CI 0.77-0.90) and 0.95 (95% CI 0.93-0.97), indicating good and excellent, respectively. The mean of the sum of the health literacy skills was 115.1 (median 115; range=80-166) and the mean for information navigation skills was 25.9 (median 26; range=17-36), respectively. Health literacy and information navigation skills were moderately correlated (r=0.54; 95% CI 0.033-0.822; P=.04). Among the four stages of health literacy, understanding and appraising (r=0.53; 95% CI 0.025-0.820; P=.04) were moderately correlated with information navigation skills (r=0.52; 95% CI 0.013-0.816; P=.046). The participants had no difficulties operating and browsing the internet and considered medical and public institution websites to be reliable; however, due to unfamiliarity with medical terms, they had difficulties choosing a site from the results obtained and comparing and synthesizing information provided by different sites. They also looked for sites providing orderly information in plain language but provided explanations from sites that gave inadequate interpretations of information. Conclusions: This study revealed interactions between searching the internet for, and understanding, medical information by analyzing the processes of information seeking online, physicians’ evaluations and comments about the participants’ explanations, and the participants’ perceptions. %M 31586366 %R 10.2196/13240 %U http://cancer.jmir.org/2019/2/e13240/ %U https://doi.org/10.2196/13240 %U http://www.ncbi.nlm.nih.gov/pubmed/31586366 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13022 %T From Information Seekers to Innovators: Qualitative Analysis Describing Experiences of the Second Generation of E-Patients %A Scott Duncan,Therese %A Riggare,Sara %A Koch,Sabine %A Sharp,Lena %A Hägglund,Maria %+ Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, Stockholm, 17177, Sweden, 46 73 512 40 63, therese.scott.duncan@ki.se %K consumer health informatics %K eHealth %K qualitative research %K self-care %K motivation %D 2019 %7 15.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Current health care systems are rarely designed to meet the needs of people living with chronic conditions. However, some patients and informal caregivers are not waiting for the health care system to redesign itself. These individuals are sometimes referred to as e-patients. The first generation of e-patients used the internet for finding information and for communicating with peers. Compared with the first generation, the second generation of e-patients collects their own health data and appears to be more innovative. Objective: The aim of this study was to describe the second generation of e-patients through exploration of their active engagement in their self-care and health care. Methods: Semistructured interviews were conducted with 10 patients with chronic conditions and 5 informal caregivers. They were all recruited through a Web-based advertisement. Data were analyzed according to the framework analysis approach, using the 3 concepts of the self-determination theory—autonomy, relatedness, and competence—at the outset. Results: Study participants were actively engaged in influencing their self-care and the health care system to improve their own health, as well as the health of others. This occurred at different levels, such as using their own experience when giving presentations and lectures to health care professionals and medical students, working as professional peers in clinical settings, performing self-tracking, contributing with innovations, and being active on social media. When interaction with health care providers was perceived as being insufficient, the participants sought support through their peers, which showed strong relatedness. Competence increased through the use of technology and learning experiences with peers. Their autonomy was important but was sometimes described as involuntary and to give up was not an option for them. Conclusions: Like the first generation of e-patients, the participants frequently searched for Web-based information. However, the second generation of e-patients also produce their own health data, which they learn from and share. They also engage in the innovation of digital tools to meet health-related needs. Utilizing technological developments comes naturally to the second generation of e-patients, even if the health care system is not prepared to support them under these new circumstances. %M 31418421 %R 10.2196/13022 %U http://www.jmir.org/2019/8/e13022/ %U https://doi.org/10.2196/13022 %U http://www.ncbi.nlm.nih.gov/pubmed/31418421 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 3 %P e13619 %T Influence of Enthusiastic Language on the Credibility of Health Information and the Trustworthiness of Science Communicators: Insights From a Between-Subject Web-Based Experiment %A König,Lars %A Jucks,Regina %+ Department of Psychology, University of Münster, Fliednerstraße 21, Münster, 48149, Germany, 49 2518323685, lars.koenig@uni-muenster.de %K health communication %K information seeking behavior %K trust %K language %K occupations %K deep learning %K FMRI %K source credibility %K persuasiveness %D 2019 %7 12.8.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: To decide whether online health information is reliable, information seekers apply 2 stretegies: first, information seekers can make credibility judgments by using their prior knowledge to evaluate the validity of the encountered health claim. Second, instead of evaluating the health claim itself, information seekers can make trustworthiness judgments by evaluating the character of the information source. In recent years, information givers from various professions have begun to use enthusiastic language to disseminate their information and persuade their audiences. Objective: To systematically explore this phenomenon, the goal of this study was to answer the following research questions: (1) does an enthusiastic language style, in comparison with a neutral language style, increase the trustworthiness of a person arguing in an online health forum and the credibility of his or her information? (2) does working for a university, in comparison with working for a lobbying organization, increase the trustworthiness of a person arguing in an online health forum and the credibility of his or her information? (3) does working for a university in combination with using an enthusiastic language style result in especially high trustworthiness and credibility ratings? Methods: In a 2x2 between-subject online experiment, 270 participants read a post from an online health forum and subsequently rated the trustworthiness of the forum post author and the credibility of his information. A total of 2 aspects of the forum post varied, namely the professional affiliation of the forum post author (whether the person introduced himself as a scientist or a lobbyist) and his language style (whether he used a neutral language style or an enthusiastic language style). Results: When the forum post author used an enthusiastic language style, he was perceived as more manipulative (P<.001), less knowledgeable (P<.001), and his information was perceived as less credible (P<.001). Overall, scientists were perceived as less manipulative (P=.04) than lobbyists. Furthermore, language style and professional affiliation interacted: When the forum post author was a lobbyist, language style did not affect integrity (P=.96) and benevolence (P=.79) ratings. However, when the forum post author was a scientist, enthusiastic language led to lower integrity (P=.002) and benevolence (P<.001) ratings than neutral language. Conclusions: The current findings illustrate that health information seekers do not just react to online health information itself. In addition, they are also sensitive to the ways in which health information is presented (“Which langue style is used to communicate health information?”) and who presents it (“Who does the health information source work for?”). %M 31411138 %R 10.2196/13619 %U http://www.i-jmr.org/2019/3/e13619/ %U https://doi.org/10.2196/13619 %U http://www.ncbi.nlm.nih.gov/pubmed/31411138 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e14105 %T Differences in Perceptions of Health Information Between the Public and Health Care Professionals: Nonprobability Sampling Questionnaire Survey %A Gesser-Edelsburg,Anat %A Abed Elhadi Shahbari,Nour %A Cohen,Ricky %A Mir Halavi,Adva %A Hijazi,Rana %A Paz-Yaakobovitch,Galit %A Birman,Yael %+ Health and Risk Communication Research Center and School of Public Health, University of Haifa, Haifa, 3498838, Israel, 972 544 243530, ageser@univ.haifa.ac.il %K health information-seeking %K reading and understanding %K quality criteria for health journalists %K Web-based and newspaper health information sources %K journalistic articles %K public healthcare workers and the general public %D 2019 %7 03.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In the new media age, the public searches for information both online and offline. Many studies have examined how the public reads and understands this information but very few investigate how people assess the quality of journalistic articles as opposed to information generated by health professionals. Objective: The aim of this study was to examine how public health care workers (HCWs) and the general public seek, read, and understand health information and to investigate the criteria by which they assess the quality of journalistic articles. Methods: A Web-based nonprobability sampling questionnaire survey was distributed to Israeli HCWs and members of the public via 3 social media outlets: Facebook, WhatsApp, and Instagram. A total of 979 respondents participated in the online survey via the Qualtrics XM platform. Results: The findings indicate that HCWs find academic articles more reliable than do members of the general public (44.4% and 28.4%, respectively, P<.001). Within each group, we found disparities between the places where people search for information and the sources they consider reliable. HCWs consider academic articles to be the most reliable, yet these are not their main information sources. In addition, HCWs often use social networks to search for information (18.2%, P<.001), despite considering them very unreliable (only 2.2% found them reliable, P<.001). The same paradoxes were found among the general public, where 37.5% (P<.001) seek information via social networks yet only 8.4% (P<.001) find them reliable. Out of 6 quality criteria, 4 were important both to HCWs and to the general public. Conclusions: In the new media age where information is accessible to all, the quality of articles about health is of critical importance. It is important that the criteria examined in this research become the norm in health writing for all stakeholders who write about health, whether they are professional journalists or citizen journalists writing in the new media. %M 31271145 %R 10.2196/14105 %U https://www.jmir.org/2019/7/e14105/ %U https://doi.org/10.2196/14105 %U http://www.ncbi.nlm.nih.gov/pubmed/31271145 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 6 %P e12848 %T Preferences of Information Dissemination on Treatment for Bipolar Disorder: Patient-Centered Focus Group Study %A Kerner,Berit %A Crisanti,Annette S %A DeShaw,Jason L %A Ho,Janika-Marie G %A Jordan,Kimmie %A Krall,Ronald L %A Kuntz,Matt J %A Mazurie,Aurélien J %A Nestsiarovich,Anastasiya %A Perkins,Douglas J %A Schroeter,Quentin L %A Smith,Alicia N %A Tohen,Mauricio %A Volesky,Emma %A Zhu,Yiliang %A Lambert,Christophe G %+ Division of Translational Informatics, Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10-5550, Albuquerque, NM, 87131, United States, 1 505 272 9709, CGLambert@unm.edu %K internet %K information seeking %K psychiatry %K bipolar disorder %K patient-physician relationship %K decision-making %K patient education %K therapeutics %D 2019 %7 25.06.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Patient education has taken center stage in successfully shared decision making between patients and health care providers. However, little is known about how patients with bipolar disorder typically obtain information on their illness and the treatment options available to them. Objective: This study aimed to obtain the perspectives of patients with bipolar disorder and their family members on the preferred and most effectively used information channels on bipolar disorder and the available treatment options. Methods: We conducted nine focus groups in Montana, New Mexico, and California, in which we surveyed 84 individuals including patients with bipolar disorder and family members of patients with bipolar disorder. The participants were recruited using National Alliance on Mental Illness mailing lists and websites. Written verbatim responses to semistructured questionnaires were analyzed using summative content analysis based on grounded theory. Two annotators coded and analyzed the data on the sentence or phrase level to create themes. Relationships between demographics and information channel were also examined using the Chi-square and Fisher exact tests. Results: The focus group participants mentioned a broad range of information channels that were successfully used in the past and could be recommended for future information dissemination. The majority of participants used providers (74%) and internet-based resources (75%) as their main information sources. There was no association between internet use and basic demographics such as age or geographical region of the focus groups. Patients considered time constraints and the fast pace in which an overwhelming amount of information is often presented by the provider as major barriers to successful provider-patient interactions. If Web-based channels were used, the participants perceived information obtained through Web-based channels as more helpful than information received in the provider’s office (P<.05). Conclusions: Web-based resources are increasingly used by patients with bipolar disorder and their family members to educate themselves about the disease and its treatment. Although provider-patient interactions are frequently perceived to be burdened with time constraints, Web-based information sources are considered reliable and helpful. Future research should explore how high-quality websites could be used to empower patients and improve provider-patient interactions with the goal of enhancing shared decision making between patients and providers. %M 31237566 %R 10.2196/12848 %U http://mental.jmir.org/2019/6/e12848/ %U https://doi.org/10.2196/12848 %U http://www.ncbi.nlm.nih.gov/pubmed/31237566 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e13082 %T Symptoms Prompting Interest in Celiac Disease and the Gluten-Free Diet: Analysis of Internet Search Term Data %A Lebwohl,Benjamin %A Yom-Tov,Elad %+ Microsoft Research, 13 Shenkar Street, Herzeliya, 46733, Israel, 972 747111359, eladyt@yahoo.com %K celiac disease %K gluten %K epidemiology %D 2019 %7 08.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Celiac disease, a common immune-based disease triggered by gluten, has diverse clinical manifestations, and the relative distribution of symptoms leading to diagnosis has not been well characterized in the population. Objective: This study aimed to use search engine data to identify a set of symptoms and conditions that would identify individuals at elevated likelihood of a subsequent celiac disease diagnosis. We also measured the relative prominence of these search terms before versus after a search related to celiac disease. Methods: We extracted English-language queries submitted to the Bing search engine in the United States and identified those who submitted a new celiac-related query during a 1-month period, without any celiac-related queries in the preceding 9 months. We compared the ratio between the number of times that each symptom or condition was asked in the 14 days preceding the first celiac-related query of each person and the number of searches for that same symptom or condition in the 14 days after the celiac-related query. Results: We identified 90,142 users who made a celiac-related query, of whom 6528 (7%) exhibited sustained interest, defined as making a query on more than 1 day. Though a variety of symptoms and associated conditions were also queried before a celiac-related query, the maximum area under the receiver operating characteristic curve was 0.53. The symptom most likely to be queried more before than after a celiac-related query was diarrhea (query ratio [QR] 1.28). Extraintestinal symptoms queried before a celiac disease query included headache (QR 1.26), anxiety (QR 1.10), depression (QR 1.03), and attention-deficit hyperactivity disorder (QR 1.64). Conclusions: We found an increase in antecedent searches for symptoms known to be associated with celiac disease, a rise in searches for depression and anxiety, and an increase in symptoms that are associated with celiac disease but may not be reported to health care providers. The protean clinical manifestations of celiac disease are reflected in the diffuse nature of antecedent internet queries of those interested in celiac disease, underscoring the challenge of effective case-finding strategies. %M 30958273 %R 10.2196/13082 %U https://www.jmir.org/2019/4/e13082/ %U https://doi.org/10.2196/13082 %U http://www.ncbi.nlm.nih.gov/pubmed/30958273 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e10831 %T Online Health Information Seeking and eHealth Literacy Among Patients Attending a Primary Care Clinic in Hong Kong: A Cross-Sectional Survey %A Wong,David Ka-Ki %A Cheung,Man-Kuen %+ University Health Service, The University of Hong Kong, 2/F Meng Wah Complex, The University of Hong Kong, Pokfulam,, China (Hong Kong), 852 39172502, dkkw@hku.hk %K online health information seeking %K eHealth literacy %K primary care %K Hong Kong %D 2019 %7 27.03.2019 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 30916666 %R 10.2196/10831 %U http://www.jmir.org/2019/3/e10831/ %U https://doi.org/10.2196/10831 %U http://www.ncbi.nlm.nih.gov/pubmed/30916666 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11279 %T Characterizing the Digital Health Citizen: Mixed-Methods Study Deriving a New Typology %A Powell,John %A Deetjen,Ulrike %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865617768, john.powell@phc.ox.ac.uk %K eHealth %K health information seeking %K perceived health %K health service use %K health outcomes %K digital divide %K digital inequalities %D 2019 %7 05.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A key challenge for health systems harnessing digital tools and services is that of digital inclusion. Typically, digital inequalities are conceptualized in relation to unequal access or usage. However, these differences do not fully explain differences in health behavior as a result of health-related internet use. Objective: Our objective was to derive a new typology of health internet users based on their antecedent motivations and enablers, to explain how individuals’ different orientations influence their health behavior. Methods: We used a mixed-methods design using (1) qualitative data from 43 semistructured interviews about individuals’ general and health-related internet use, and how this influenced their health perception and their help-seeking decisions, and (2) quantitative data from the Oxford Internet Surveys (OxIS), a household survey of 2150 adults in England about their internet use and other characteristics. We used the interview data to identify constructs that described motivations and enablers affecting how internet use shaped respondents’ health perception and health service use. We then used these constructs to identify variables in OxIS, which provided a quantitative measure of these constructs. We then undertook a hierarchical cluster analysis of these constructs, using the numerical variables, to derive a proposed typology of health information seekers. Results: Both the qualitative findings and the subsequent cluster analysis suggested the existence of 6 types of individuals, categorized as learners, pragmatists, skeptics, worriers, delegators, and adigitals. Learners had a strong desire to understand health better. They used the internet to make decisions about whether they needed to see a professional and to learn about their and others’ health. Pragmatists primarily used the internet to decide whether seeing a doctor was worthwhile. Skeptics were skeptical of physicians and the medical system and valued the internet for solving health problems that doctors may not be able to deal with. Worriers found it difficult to interpret health information online, described health information seeking online as frightening, and reported a critical attitude toward online health information despite seeking it frequently. Delegators comprised nonusers and users valuing the internet as an information source, but not necessarily wanting or being able to use the internet themselves. Adigitals comprised many nonusers, but also users, who did not see the internet as a useful information tool and presented strong views on its low suitability for health care. Conclusions: This research supports a shift in the understanding of the digital divide in health, away from only access and usage issues, toward also conceptualizing an outcomes divide, whereby different types of health behavior result from the differing orientations of internet users accessing online health information. This new typology can be used to inform digital inclusion policies in health systems. %M 30835238 %R 10.2196/11279 %U https://www.jmir.org/2019/3/e11279/ %U https://doi.org/10.2196/11279 %U http://www.ncbi.nlm.nih.gov/pubmed/30835238 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11240 %T Electronic Health Behaviors Among US Adults With Chronic Disease: Cross-Sectional Survey %A Madrigal,Lillian %A Escoffery,Cam %+ Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 727 3956, lmadrig@emory.edu %K information seeking behavior %K chronic disease %K health promotion %K eHealth %K mobile apps %K patient portals %D 2019 %7 05.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: With increased access to technology and the internet, there are many opportunities for utilizing electronic health (eHealth), internet, or technology-delivered health services and information for the prevention and management of chronic diseases. Objective: The aim of this paper was to explore (1) the differences in technology use, (2) Web-based health information seeking and use behaviors, (3) attitudes toward seeking health information on the Web, and (4) the level of eHealth literacy between adults aged 18 and 64 years with and without chronic disease. Methods: A cross-sectional internet survey was conducted in March 2017 with 401 US adults. Participant responses were examined to understand associations between chronic disease status and eHealth behaviors such as internet health-seeking behaviors and Web-based behaviors related to health, tracking health indicators with a mobile app, patient portal use, and preferences for health information. Results: About 1 in 3 (252/401, 37.2%) participants reported at least 1 chronic disease diagnosis. Seventy-five percent (301/401) of all participants reported having ever searched for health information on the Web. Participants with a chronic disease reported significantly higher instances of visiting and talking to a health care provider based on health information found on the Web (40.0% [48/120] vs 25.8% [46/178], χ22=6.7; P=.01; 43.3% [52/120] vs 27.9% [50/179]; χ22=7.6; P=.006). The uses of health information found on the Web also significantly differed between participants with and without chronic diseases in affecting a decision about how to treat an illness or condition (49.2% [59/120] vs 35.0% [63/180], χ23=6.7; P=.04), changing the way they cope with a chronic condition or manage pain (40.8% [49/120] vs 19.4% [35/180], χ22=16.3; P<.001), and leading them to ask a doctor new questions or get a second opinion (37.5% [45/120] vs 19.6% [35/179], χ22=11.8; P<.001). Chronic disease participants were significantly more likely to be tracking health indicators (43.9% [65/148] vs 28.3%, [71/251] χ22=10.4; P=.006). In addition, participants with chronic disease diagnosis reported significantly higher rates of patient portal access (55.0% [82/149] vs 42.1% [106/252], χ22=6.3; P=.01) and use (40.9% [61/149] vs 21.0% [53/252], χ22=18.2; P<.001). Finally, both groups reported similar perceived skills in using the internet for health information on the eHealth Literacy Scale (eHEALS). The majority of participants responded positively when asked about the usefulness of health information and importance of accessing health resources on the Web. Conclusions: The high rates of reported information seeking and use of internet-based health technology among participants with chronic disease may reflect the uptake in eHealth to help manage chronic disease conditions. Health care providers and educators should continue to seek ways to interact and support patients in their management of chronic disease through eHealth platforms, including capitalizing on Web-based resources, patient portals, and mobile phone apps for disease education and monitoring. %M 30835242 %R 10.2196/11240 %U https://www.jmir.org/2019/3/e11240/ %U https://doi.org/10.2196/11240 %U http://www.ncbi.nlm.nih.gov/pubmed/30835242 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12400 %T Online Information-Seeking About Potential Breast Cancer Symptoms: Capturing Online Behavior With an Internet Browsing Tracking Tool %A Marcu,Afrodita %A Muller,Cecile %A Ream,Emma %A Whitaker,Katriina L %+ School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, GU2 7XH, United Kingdom, 44 0148 36 82515, afrodita.marcu@surrey.ac.uk %K breast cancer %K health information %K internet search %K online information seeking %D 2019 %7 06.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: People engage in health information-seeking online when experiencing unusual or unfamiliar bodily changes. It is not well understood how people consult the internet for health information after the onset of unfamiliar symptoms and before receiving a potential diagnosis and how online information-seeking can help people appraise their symptoms. This lack of evidence may be partly due to methodological limitations in capturing in real time the online information-seeking process. Objective: We explored women’s symptom attribution and online health information-seeking in response to a hypothetical and unfamiliar breast change suggestive of cancer (nipple rash). We also aimed to establish the feasibility of capturing in real time the online information-seeking process with a tool designed to track participant online searches and visited websites, the Vizzata browser tracker. Methods: An online survey was completed by 56 cancer-free women (mean age 60.34 [SD 7.73] years) responding to a scenario asking them to imagine noticing a red scaly rash on the nipple. Participants were asked to make symptom attributions when presented with the scenario (T1) and again after seeking information online (T2). The online tracking tool, embedded in the survey, was used to capture in real time participant search terms and accessed websites. Results: The tracking tool captured the search terms and accessed websites of most of the participants (46/56, 82%). For the rest (10/56, 18%), there was evidence of engagement in online information-seeking (eg, medical terminology and cancer attribution at T2) despite their searching activity not being recorded. A total of 25 participants considered cancer as a potential cause for the nipple rash at T1, yet only one of these used cancer as a search term. Most participants (40/46, 87%) used rash-related search terms, particularly nipple rash and rash on nipple. The majority (41/46, 89%) accessed websites containing breast cancer information, with the National Health Service webpage “Paget disease of the nipple” being the most visited one. At T2, after engaging in the internet search task, more participants attributed the nipple rash to breast cancer than at T1 (37/46, 66% vs 25/46, 45%), although a small number of participants (6/46) changed from making a cancer attribution at T1 to a noncancer one at T2. Conclusions: Making a cancer attribution for an unfamiliar breast change did not necessarily translate into cancer-termed searches. Equally, not all internet searches led to a cancer attribution. The findings suggest that online information-seeking may not necessarily help women who experience unfamiliar breast cancer symptoms understand their condition. Despite some technical issues, this study showed that it is feasible to use an online browser tracking tool to capture in real time information-seeking about unfamiliar symptoms. %M 30724741 %R 10.2196/12400 %U http://www.jmir.org/2019/2/e12400/ %U https://doi.org/10.2196/12400 %U http://www.ncbi.nlm.nih.gov/pubmed/30724741 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e10986 %T Consumer Health Search on the Web: Study of Web Page Understandability and Its Integration in Ranking Algorithms %A Palotti,Joao %A Zuccon,Guido %A Hanbury,Allan %+ Institute for Information Systems Engineering, Technische Universität Wien, Favoritenstraße 9-11/194 04, Vienna, 1040, Austria, 43 158801188310, allan.hanbury@tuwien.ac.at %K readability %K literacy %K comprehension %K patients %K machine learning %D 2019 %7 30.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Understandability plays a key role in ensuring that people accessing health information are capable of gaining insights that can assist them with their health concerns and choices. The access to unclear or misleading information has been shown to negatively impact the health decisions of the general public. Objective: The aim of this study was to investigate methods to estimate the understandability of health Web pages and use these to improve the retrieval of information for people seeking health advice on the Web. Methods: Our investigation considered methods to automatically estimate the understandability of health information in Web pages, and it provided a thorough evaluation of these methods using human assessments as well as an analysis of preprocessing factors affecting understandability estimations and associated pitfalls. Furthermore, lessons learned for estimating Web page understandability were applied to the construction of retrieval methods, with specific attention to retrieving information understandable by the general public. Results: We found that machine learning techniques were more suitable to estimate health Web page understandability than traditional readability formulae, which are often used as guidelines and benchmark by health information providers on the Web (larger difference found for Pearson correlation of .602 using gradient boosting regressor compared with .438 using Simple Measure of Gobbledygook Index with the Conference and Labs of the Evaluation Forum eHealth 2015 collection). Conclusions: The findings reported in this paper are important for specialized search services tailored to support the general public in seeking health advice on the Web, as they document and empirically validate state-of-the-art techniques and settings for this domain application. %M 30698536 %R 10.2196/10986 %U http://www.jmir.org/2019/1/e10986/ %U https://doi.org/10.2196/10986 %U http://www.ncbi.nlm.nih.gov/pubmed/30698536 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e11237 %T Health Information–Seeking Behaviors of Family Caregivers: Analysis of the Health Information National Trends Survey %A Bangerter,Lauren R %A Griffin,Joan %A Harden,Kristin %A Rutten,Lila J %+ Robert D and Patricia E Kern Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, United States, 1 5072932509, bangerter.lauren@mayo.edu %K disparities %K family caregivers %K Health Information National Trends Survey %K internet use %K mobile phone %D 2019 %7 14.01.2019 %9 Original Paper %J JMIR Aging %G English %X Background: The growing population of aging adults relies on informal caregivers to help meet their health care needs, get help with decision making, and gather health information. Objective: The objective of this study was to examine health information–seeking behaviors among caregivers and to identify caregiver characteristics that contribute to difficulty in seeking health information. Methods: Data from the Health Information National Trends Survey 5, Cycle 1 (N=3181) were used to compare health information seeking of caregivers (n=391) with noncaregivers (n=2790). Results: Caregivers sought health information for themselves and others using computers, smartphones, or other electronic means more frequently than noncaregivers. Caregivers born outside of the United States reported greater difficulty seeking health information (beta=.42; P=.02). Nonwhite caregivers (beta =−.33; P=.03), those with less education (beta =−.35; P=.02), those with private insurance (beta =−.37; P=.01), and those without a regular health care provider (beta =−.35; P=.01) had less confidence seeking health information. Caregivers with higher income had more confidence (beta =.12; P≤.001) seeking health information. Conclusions: This study highlights the prevalence of electronic means to find health information among caregivers. Notable differences in difficulty and confidence in health information seeking exist between caregivers, indicating the need for more attention to the socioeconomic status and caregivers born outside of the United States. Findings can guide efforts to optimize caregivers’ health information–seeking experiences. %M 31518309 %R 10.2196/11237 %U https://aging.jmir.org/2019/1/e11237/ %U https://doi.org/10.2196/11237 %U http://www.ncbi.nlm.nih.gov/pubmed/31518309 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e16 %T Importance and Presence of High-Quality Evidence for Clinical Decisions in Neurosurgery: International Survey of Neurosurgeons %A Martens,Jill %A de Jong,Guido %A Rovers,Maroeska %A Westert,Gert %A Bartels,Ronald %+ Neurosurgical Center Nijmegen, Department of Neurosurgery, Radboud University Medical Center, Department of Neurosurgery, huispost 636, Postbus 9101, Nijmegen, 6500 HB, Netherlands, 31 681557132, jill.martens@radboudumc.nl %K evidence-based medicine %K neurosurgery %K levels of evidence %D 2018 %7 12.10.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: The publication rate of neurosurgical guidelines has increased tremendously over the past decade; however, only a small proportion of clinical decisions appear to be based on high-quality evidence. Objective: The aim was to evaluate the evidence available within neurosurgery and its value within clinical practice according to neurosurgeons. Methods: A Web-based survey was sent to 2552 neurosurgeons, who were members of the European Association of Neurosurgical Societies. Results: The response rate to the survey was 6.78% (173/2552). According to 48.6% (84/173) of the respondents, neurosurgery clinical practices are based on less evidence than other medical specialties and not enough high-quality evidence is available; however, 84.4% (146/173) of the respondents believed neurosurgery is amenable to evidence. Of the respondents, 59.0% (102/173) considered the neurosurgical guidelines in their hospital to be based on high-quality evidence, most of whom considered their own treatments to be based on high-quality (level I and/or level II) data (84.3%, 86/102; significantly more than for the neurosurgeons who did not consider the hospital guidelines to be based on high-quality evidence: 55%, 12/22; P<.001). Also, more neurosurgeons with formal training believed they could understand, criticize, and interpret statistical outcomes presented in journals than those without formal training (93%, 56/60 and 68%, 57/84 respectively; P<.001). Conclusions: According to the respondents, neurosurgery is based on high-quality evidence less often than other medical specialties. The results of the survey indicate that formal training in evidence-based medicine would enable neurosurgeons to better understand, criticize, and interpret statistical outcomes presented in journals. %M 30314961 %R 10.2196/ijmr.9617 %U http://www.i-jmr.org/2018/2/e16/ %U https://doi.org/10.2196/ijmr.9617 %U http://www.ncbi.nlm.nih.gov/pubmed/30314961 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10958 %T Online Peer-to-Peer Mentoring Support for Youth with Hemophilia: Qualitative Needs Assessment %A Breakey,Vicky R %A Bouskill,Vanessa %A Nguyen,Cynthia %A Luca,Stephanie %A Stinson,Jennifer N %A Ahola Kohut,Sara %+ Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children’s Hospital, HSC 3N27a, 1280 Main Street W, Hamilton, ON, L8S 4K1, Canada, 1 905 521 2100 ext 73080, breakev@mcmaster.ca %K hemophilia %K adolescents %K transition %K self-management %K education %K internet %K mentoring %D 2018 %7 10.07.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: To support adolescents through transition from pediatrics to adult care, health care providers and families help teens gain knowledge and develop self-management skills. Peer mentoring can provide meaningful support and has been associated with improved health outcomes in patients with other chronic conditions. Peer mentoring is an appealing way to provide support, but it is imperative to consider the unique needs of adolescents to ensure its success. Objective: The objective of our study was to identify the peer mentoring wants and needs of youth with hemophilia in order to guide the development of a new program. Methods: In this qualitative study, we interviewed a convenience sample of youth with hemophilia from 2 Canadian hemophilia treatment centers. Two iterative cycles of audiorecorded, semistructured individual interviews were conducted. Descriptive statistics and content analyses were used to organize data into categories that reflected emerging themes. Results: In total, we recruited 23 participants aged 12-20 years, with a mean age of 14.91 (2.57) years. When asked about program design, participants weighed the importance of flexibility in delivery (eg, Web-based, in person, text messaging [short message service]), content (eg, structured vs unstructured), frequency of sessions, and length of the program. Participants identified some potential challenges such as scheduling issues, comfort level for disease discussion, and discordant mentor-mentee personality types. The program was viewed as a positive medium for connecting peers with hemophilia. Conclusions: Adolescents with hemophilia expressed interest in a peer mentoring program and provided valuable insight that will be applied in the development of a peer mentoring program for youth with hemophilia. %M 31518296 %R 10.2196/10958 %U http://pediatrics.jmir.org/2018/2/e10958/ %U https://doi.org/10.2196/10958 %U http://www.ncbi.nlm.nih.gov/pubmed/31518296 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10141 %T Discovery of and Interest in Health Apps Among Those With Mental Health Needs: Survey and Focus Group Study %A Schueller,Stephen M %A Neary,Martha %A O'Loughlin,Kristen %A Adkins,Elizabeth C %+ Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, CBITs, Chicago, IL, 60614, United States, 1 312 503 1232, schueller@northwestern.edu %K mHealth %K mental health %K mobile apps %K consumer preference %K focus groups %D 2018 %7 11.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: A large number of health apps are available directly to consumers through app marketplaces. Little information is known, however, about how consumers search for these apps and which factors influence their uptake, adoption, and long-term use. Objective: The aim of this study was to understand what people look for when they search for health apps and the aspects and features of those apps that consumers find appealing. Methods: Participants were recruited from Northwestern University’s Center for Behavioral Intervention Technologies’ research registry of individuals with mental health needs. Most participants (n=811) completed a survey asking about their use and interest in health and mental health apps. Local participants were also invited to participate in focus groups. A total of 7 focus groups were conducted with 30 participants that collected more detailed information about their use and interest in health and mental health apps. Results: Survey participants commonly found health apps through social media (45.1%, 366/811), personal searches (42.7%, 346/811), or word of mouth (36.9%, 299/811), as opposed to professional sources such as medical providers (24.6%, 200/811). From the focus groups, common themes related to uptake and use of health apps included the importance of personal use before adoption, specific features that users found desirable, and trusted sources either developing or promoting the apps. Conclusions: As the number of mental health and health apps continue to increase, it is imperative to better understand the factors that impact people’s adoption and use of such technologies. Our findings indicated that a number of factors—ease of use, aesthetics, and individual experience—drove adoption and use and highlighted areas of focus for app developers and disseminators. %M 29891468 %R 10.2196/10141 %U http://www.jmir.org/2018/6/e10141/ %U https://doi.org/10.2196/10141 %U http://www.ncbi.nlm.nih.gov/pubmed/29891468 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e12 %T Exploring Health Information-Seeking Preferences of Older Adults With Hypertension: Quasi-Experimental Design %A Sak,Gabriele %A Schulz,Peter Johannes %+ Institute of Communication & Health, Faculty of Communication Sciences, Università della Svizzera italiana, Via G Buffi 6, Lugano, 6904, Switzerland, 41 58 666 44 88, gabriele.sak@usi.ch %K desire for health information %K assisted computer-based information search %K decision self-efficacy %K medical decision making %K senior hypertensive patients %K quasi-experimental design %K Switzerland %D 2018 %7 30.05.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Patients’ engagement in health care decision making is constituted by at least two behaviors: health information seeking and active involvement in medical decisions. Previous research reported that older adults desire a lot of information, but want to participate in decision making to a lesser degree. However, there is only limited evidence on the effect of desire for health information on seniors’ perceived confidence in making an informed choice (ie, decision self-efficacy). Objective: The goal of this study was to investigate the role desire for health information has for older patients. More specifically, it tested whether decision self-efficacy increases as a function of an assisted computer-based information search. Additionally, the study allowed insights into the sources seniors with hypertension prefer to consult. Methods: A sample of 101 senior citizens (aged ≥60 years) with high blood pressure in the Italian-speaking part of Switzerland answered a questionnaire before and after an informational intervention was applied. The intervention consisted of offering additional information on hypertension from five different sources and of providing the information the participant desired. Preference for receiving this information was the major independent variable. The main outcome measure was decision self-efficacy (assessed at baseline and posttest). Analyses of covariance were conducted to detect differences between and within who desired additional hypertension-related content (intervention group) and “information avoiders” (control group). Results: Health care professionals firmly remain the preferred and most trusted source of health information for senior patients. The second most consulted source was the internet (intervention group only). However, among the total sample, the internet obtained the lowest credibility score. A significant increase in decision self-efficacy occurred in seniors consulting additional information compared to information avoiders (F1,93=28.25, P<.001). Conclusions: Consulting health information on a computer screen, and assistance by a computer-savvy person, may be a helpful activity to increase perceived confidence in making treatment decisions in seniors with hypertension. %M 31758784 %R 10.2196/cardio.8903 %U http://cardio.jmir.org/2018/1/e12/ %U https://doi.org/10.2196/cardio.8903 %U http://www.ncbi.nlm.nih.gov/pubmed/31758784 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e10 %T Assessing Unmet Information Needs of Breast Cancer Survivors: Exploratory Study of Online Health Forums Using Text Classification and Retrieval %A McRoy,Susan %A Rastegar-Mojarad,Majid %A Wang,Yanshan %A Ruddy,Kathryn J %A Haddad,Tufia C %A Liu,Hongfang %+ Department of Electrical Engineering and Computer Science, University of Wisconsin-Milwaukee, College of Engineering & Applied Science, PO Box 784, Milwaukee, WI, 53201, United States, 1 414 229 6695, mcroy@uwm.edu %K online health forum %K automated content analysis %K text retrieval %K text classification %D 2018 %7 15.05.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Patient education materials given to breast cancer survivors may not be a good fit for their information needs. Needs may change over time, be forgotten, or be misreported, for a variety of reasons. An automated content analysis of survivors' postings to online health forums can identify expressed information needs over a span of time and be repeated regularly at low cost. Identifying these unmet needs can guide improvements to existing education materials and the creation of new resources. Objective: The primary goals of this project are to assess the unmet information needs of breast cancer survivors from their own perspectives and to identify gaps between information needs and current education materials. Methods: This approach employs computational methods for content modeling and supervised text classification to data from online health forums to identify explicit and implicit requests for health-related information. Potential gaps between needs and education materials are identified using techniques from information retrieval. Results: We provide a new taxonomy for the classification of sentences in online health forum data. 260 postings from two online health forums were selected, yielding 4179 sentences for coding. After annotation of data and training alternative one-versus-others classifiers, a random forest-based approach achieved F1 scores from 66% (Other, dataset2) to 90% (Medical, dataset1) on the primary information types. 136 expressions of need were used to generate queries to indexed education materials. Upon examination of the best two pages retrieved for each query, 12% (17/136) of queries were found to have relevant content by all coders, and 33% (45/136) were judged to have relevant content by at least one. Conclusions: Text from online health forums can be analyzed effectively using automated methods. Our analysis confirms that breast cancer survivors have many information needs that are not covered by the written documents they typically receive, as our results suggest that at most a third of breast cancer survivors’ questions would be addressed by the materials currently provided to them. %M 29764801 %R 10.2196/cancer.9050 %U http://cancer.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/cancer.9050 %U http://www.ncbi.nlm.nih.gov/pubmed/29764801 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e186 %T Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search %A Cartwright,Alice F %A Karunaratne,Mihiri %A Barr-Walker,Jill %A Johns,Nicole E %A Upadhyay,Ushma D %+ Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, United States, 1 510 986 8946, ushma.upadhyay@ucsf.edu %K abortion seekers %K reproductive health %K internet %K access to information %K information seeking %K abortion patients %K reproductive health services %K information seeking behavior %D 2018 %7 14.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Abortion is a common medical procedure, yet its availability has become more limited across the United States over the past decade. Women who do not know where to go for abortion care may use the internet to find abortion facility information, and there appears to be more online searches for abortion in states with more restrictive abortion laws. While previous studies have examined the distances women must travel to reach an abortion provider, to our knowledge no studies have used a systematic online search to document the geographic locations and services of abortion facilities. Objective: The objective of our study was to describe abortion facilities and services available in the United States from the perspective of a potential patient searching online and to identify US cities where people must travel the farthest to obtain abortion care. Methods: In early 2017, we conducted a systematic online search for abortion facilities in every state and the largest cities in each state. We recorded facility locations, types of abortion services available, and facility gestational limits. We then summarized the frequencies by region and state. If the online information was incomplete or unclear, we called the facility using a mystery shopper method, which simulates the perspective of patients calling for services. We also calculated distance to the closest abortion facility from all US cities with populations of 50,000 or more. Results: We identified 780 facilities through our online search, with the fewest in the Midwest and South. Over 30% (236/780, 30.3%) of all facilities advertised the provision of medication abortion services only; this proportion was close to 40% in the Northeast (89/233, 38.2%) and West (104/262, 39.7%). The lowest gestational limit at which services were provided was 12 weeks in Wyoming; the highest was 28 weeks in New Mexico. People in 27 US cities must travel over 100 miles (160 km) to reach an abortion facility; the state with the largest number of such cities is Texas (n=10). Conclusions: Online searches can provide detailed information about the location of abortion facilities and the types of services they provide. However, these facilities are not evenly distributed geographically, and many large US cities do not have an abortion facility. Long distances can push women to seek abortion in later gestations when care is even more limited. %M 29759954 %R 10.2196/jmir.9717 %U http://www.jmir.org/2018/5/e186/ %U https://doi.org/10.2196/jmir.9717 %U http://www.ncbi.nlm.nih.gov/pubmed/29759954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e169 %T Reducing Negative Outcomes of Online Consumer Health Information: Qualitative Interpretive Study with Clinicians, Librarians, and Consumers %A El Sherif,Reem %A Pluye,Pierre %A Thoër,Christine %A Rodriguez,Charo %+ Department of Family Medicine, McGill University, Suite 300, 5858 Chemin Cotes-des-Neiges, Montreal, QC, H3S 1Z1, Canada, 1 5146323616, reem.elsherif@mail.mcgill.ca %K consumer health information %K internet %K professional-patient relations %K qualitative research %D 2018 %7 04.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been an exponential increase in the general population’s usage of the internet and of information accessibility; the current demand for online consumer health information (OCHI) is unprecedented. There are multiple studies on internet access and usage, quality of information, and information needs. However, few studies explored negative outcomes of OCHI in detail or from different perspectives, and none examined how these negative outcomes could be reduced. Objective: The aim of this study was to describe negative outcomes associated with OCHI use in primary care and identify potential preventive strategies from consumers’, health practitioners’, and health librarians’ perspectives. Methods: This included a two-stage interpretive qualitative study. In the first stage, we recruited through a social media survey, a purposeful sample of 19 OCHI users who had experienced negative outcomes associated with OCHI. We conducted semistructured interviews and performed a deductive-inductive thematic analysis. The results also informed the creation of vignettes that were used in the next stage. In the second stage, we interviewed a convenient sample of 10 key informants: 7 health practitioners (3 family physicians, 2 nurses, and 2 pharmacists) and 3 health librarians. With the support of the vignettes, we asked participants to elaborate on (1) their experience with patients who have used OCHI and experienced negative outcomes and (2) what strategies they suggest to reduce these outcomes. We performed a deductive-inductive thematic analysis. Results: We found that negative outcomes of OCHI may occur at three levels: internal (such as increased worrying), interpersonal (such as a tension in the patient-clinician relationship), and service-related (such as postponing a clinical encounter). Participants also proposed three types of strategies to reduce the occurrence of these negative outcomes, namely, providing consumers with reliable OCHI, educating consumers on how to assess OCHI websites, and helping consumers present and discuss the OCHI they find with a health professional in their social network or a librarian for instance. Conclusions: We examined negative outcomes associated with using OCHI from five complementary perspectives (consumers, family physicians, pharmacists, nurses, and health librarians). We identified a construct of OCHI use–related tension that included and framed all negative outcomes. This construct has three dimensions (three interdependent levels): internal, interpersonal, and service-related tensions. Future research can focus on the implementation and effectiveness of the proposed strategies, which might contribute to reducing these tensions. %M 29728350 %R 10.2196/jmir.9326 %U http://www.jmir.org/2018/5/e169/ %U https://doi.org/10.2196/jmir.9326 %U http://www.ncbi.nlm.nih.gov/pubmed/29728350 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e10327 %T What Do Germans Want to Know About Skin Cancer? A Nationwide Google Search Analysis From 2013 to 2017 %A Seidl,Stefanie %A Schuster,Barbara %A Rüth,Melvin %A Biedermann,Tilo %A Zink,Alexander %+ Klinikum rechts der Isar, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, Munich,, Germany, 49 8941403572, alexander.zink@tum.de %K skin cancer %K melanoma %K nonmelanoma skin cancer (NMSC) %K Google %K search analysis %K population %D 2018 %7 02.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Experts worldwide agree that skin cancer is a global health issue, but only a few studies have reported on world populations’ interest in skin cancer. Internet search data can reflect the interest of a population in different topics and thereby identify what the population wants to know. Objective: Our aim was to assess the interest of the German population in nonmelanoma skin cancer and melanoma. Methods: Google AdWords Keyword Planner was used to identify search terms related to nonmelanoma skin cancer and melanoma in Germany from November 2013 to October 2017. The identified search terms were assessed descriptively using SPSS version 24.0. In addition, the search terms were qualitatively categorized. Results: A total of 646 skin cancer-related search terms were identified with 19,849,230 Google searches in the period under review. The search terms with the highest search volume were “skin cancer” (n=2,388,500, 12.03%), “white skin cancer” (n=2,056,900, 10.36%), “basalioma” (n=907,000, 4.57%), and “melanoma” (n=717,800, 3.62%). The most searched localizations of nonmelanoma skin cancer were “nose” (n=93,370, 38.99%) and “face” (n=53,270, 22.24%), and the most searched of melanoma were “nails” (n=46,270, 70.61%) and “eye” (n=10,480, 15.99%). The skin cancer‒related category with the highest search volume was “forms of skin cancer” (n=10,162,540, 23.28%) followed by “skin alterations” (n=4,962,020, 11.36%). Conclusions: Our study provides insight into terms and fields of interest related to skin cancer relevant to the German population. Furthermore, temporal trends and courses are shown. This information could aid in the development and implementation of effective and sustainable awareness campaigns by developing information sources targeted to the population’s broad interest or by implementing new Internet campaigns. %M 29698213 %R 10.2196/10327 %U http://www.jmir.org/2018/5/e10327/ %U https://doi.org/10.2196/10327 %U http://www.ncbi.nlm.nih.gov/pubmed/29698213 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e132 %T Analysis of College Students’ Personal Health Information Activities: Online Survey %A Kim,Sujin %A Sinn,Donghee %A Syn,Sue Yeon %+ Division of Biomedical Informatics, Department of Internal Medicine, University of Kentucky, 208H, MDS Building, 725 Rose Street, Lexington, KY, United States, 1 859 218 0110, skim3@uky.edu %K health records, personal %K health information management %K student health services %D 2018 %7 20.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: With abundant personal health information at hand, individuals are faced with a critical challenge in evaluating the informational value of health care records to keep useful information and discard that which is determined useless. Young, healthy college students who were previously dependents of adult parents or caregivers are less likely to be concerned with disease management. Personal health information management (PHIM) is a special case of personal information management (PIM) that is associated with multiple interactions among varying stakeholders and systems. However, there has been limited evidence to understand informational or behavioral underpinning of the college students’ PHIM activities, which can influence their health in general throughout their lifetime. Objective: This study aimed to investigate demographic and academic profiles of college students with relevance to PHIM activities. Next, we sought to construct major PHIM-related activity components and perceptions among college students. Finally, we sought to discover major factors predicting core PHIM activities among college students we sampled. Methods: A Web survey was administered to collect responses about PHIM behaviors and perceptions among college students from the University of Kentucky from January through March 2017. A total of 1408 college students were included in the analysis. PHIM perceptions, demographics, and academic variations were used as independent variables to predict diverse PHIM activities using a principal component analysis (PCA) and hierarchical regression analyses (SPSS v.24, IBM Corp, Armonk, NY, USA). Results: Majority of the participants were female (956/1408, 67.90%), and the age distribution of this population included an adequate representation of college students of all ages. The most preferred health information resources were family (612/1408, 43.47%), health care professionals (366/1408, 26.00%), friends (27/1408, 1.91%), and the internet (157/1408, 11.15%). Organizational or curatorial activities such as Arranging, Labeling, Categorizing, and Discarding were rated low (average=3.21, average=3.02, average=2.52, and average=2.42, respectively). The PCA results suggested 3 components from perception factors labeled as follows: Assistance (alpha=.85), Awareness (alpha=.716), and Difficulty (alpha=.558). Overall, the Demographics and Academics variables were not significant in predicting dependent variables such as Labeling, Categorizing, Health Education Materials, and Discarding, whereas they were significant for other outcome variables such as Sharing, Collecting, Knowing, Insurance Information, Using, and Owning. Conclusions: College years are a significant time for students to learn decision-making skills for maintaining information, a key aspect of health records, as well as for educators to provide appropriate educational and decision aids in the environment of learning as independent adults. Our study will contribute to better understand knowledge about specific skills and perceptions for college students’ practice of effective PHIM throughout their lives. %M 29678798 %R 10.2196/jmir.9391 %U http://www.jmir.org/2018/4/e132/ %U https://doi.org/10.2196/jmir.9391 %U http://www.ncbi.nlm.nih.gov/pubmed/29678798 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e120 %T Health-Related Internet Use by Children and Adolescents: Systematic Review %A Park,Eunhee %A Kwon,Misol %+ School of Nursing, University at Buffalo, 201E Wende Hall, Buffalo, NY, 14214, United States, 1 716 829 3701, eunheepa@buffalo.edu %K Internet %K child %K adolescent %K health information %K health-related Internet use %K eHealth %D 2018 %7 03.04.2018 %9 Review %J J Med Internet Res %G English %X Background: The internet is widely used by children and adolescents, who generally have a high level of competency with technology. Thus, the internet has become a great resource for supporting youth self-care and health-related services. However, few studies have explored adolescents’ internet use for health-related matters. Objective: The objective of this systematic literature review was to examine the phenomenon of children and adolescents’ health-related internet use and to identify gaps in the research. Methods: A total of 19 studies were selected from a search of major electronic databases: PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO using the following search terms: “health-related internet use,” “eHealth,” “Internet use for health-related purpose,” “Web-based resource,” “health information seeking,” and “online resource,” combined with “child,” “adolescent,” “student,” “youth,” and “teen.” The children’s and adolescents’ ages were limited to 24 years and younger. The search was conducted from September 2015 to October 2017. The studies identified to contain youth (<24 years) health-related internet use were all published in peer-reviewed journals in the past 10 years; these studies examined general internet use seeking health care services, resources, information, or using the internet for health promotion and self-care. Studies were excluded if they explored the role of the internet as a modality for surveys, recruitment, or searching for relevant literature without specifically aiming to study participants’ health-related internet use; focused solely on quality assurance for specific websites; or were designed to test a specific internet-based intervention. Results: Interesting patterns in adolescents’ health-related internet use, such as seeking preventative health care and specific information about medical issues, were identified. Quantitative studies reported rates of the internet use and access among youth, and the purpose and patterns of health-related internet use among youth were identified. A major objective of health-related internet use is to gain information, but there are inconsistencies in adolescents’ perceptions of health-related internet use. Conclusions: This study’s findings provide important information on how youth seek information and related support systems for their health care on the internet. The conceptual and methodological limitations of the identified studies, such as the lack of a theoretical background and unrepresentative samples, are discussed, and gaps within the studies are identified for future research. This review also suggests important features for potential Web-based health interventions for children and adolescents. %M 29615385 %R 10.2196/jmir.7731 %U http://www.jmir.org/2018/4/e120/ %U https://doi.org/10.2196/jmir.7731 %U http://www.ncbi.nlm.nih.gov/pubmed/29615385 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 5 %N 1 %P e7 %T Preferences for Web-Based Information Material for Low Back Pain: Qualitative Interview Study on People Consulting a General Practitioner %A Riis,Allan %A Hjelmager,Ditte Meulengracht %A Vinther,Line Dausel %A Rathleff,Michael Skovdal %A Hartvigsen,Jan %A Jensen,Martin Bach %+ Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Fyrkildevej 7, 1. sal, Aalborg, 9220, Denmark, 45 20823660, ariis@dcm.aau.dk %K patient education as topic %K medical informatics app %K patient participation %K general practice %K low back pain %D 2018 %7 02.04.2018 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Information on self-management, including addressing people’s fears and concerns, are core aspects of managing patients with low back pain (LBP). Web apps with patient information may be used to extend patient-physician consultations and encourage self-management outside of the consultation room. It is, however, important to identify the end users’ needs and preferences in order to maximize acceptance. Objective: The aim of this study was to identify preferences for the content, design, and functionality of a Web app with evidence-based information and advice for people with LBP in Denmark. Methods: This is a phenomenological qualitative study. Adults who had consulted their general practitioner because of LBP within the past 14 days were included. Each participated in a semistructured interview, which was audiotaped and transcribed for text condensation. Interviews were conducted at the participant’s home by 2 interviewers. Participants also completed a questionnaire that requested information on age, gender, internet usage, interest in searching new knowledge, LBP-related function, and pain. Results: Fifteen 45-min interviews were conducted. Participants had a median age of 40 years (range 22-68 years) and reported a median disability of 7 points (range 0-18) using the 23-item Roland Morris Disability Questionnaire. Participants reported that Web-based information should be easy to find and read, easily overviewed, and not be overloaded with information. Subjects found existing Web-based information confusing, often difficult to comprehend, and not relevant for them, and they questioned the motives driving most hosting companies or organizations. The Patient Handbook, a Danish government-funded website that provides information to Danes about health, was mentioned as a trustworthy and preferred site when searching for information and advice regarding LBP. Conclusions: This study identified important issues to consider when developing and supplementing existing general practice treatment with Web-based information and advice for patients with LBP. Development of a Web app should consider patient input, and developers should carefully address the following domains: readability, customization, design, credibility, and usability. %M 29610108 %R 10.2196/rehab.8841 %U http://rehab.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/rehab.8841 %U http://www.ncbi.nlm.nih.gov/pubmed/29610108 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e46 %T Perceived Threat and Internet Use Predict Intentions to Get Bowel Cancer Screening (Colonoscopy): Longitudinal Questionnaire Study %A Becker,Daniela %A Grapendorf,Johannes %A Greving,Hannah %A Sassenberg,Kai %+ Social Processes Lab, Leibniz-Institut für Wissensmedien, Schleichstraße 6, Tübingen, 72076, Germany, 49 7071979231, d.becker@iwm-tuebingen.de %K emotion %K Internet %K colonoscopy %K cancer screening %D 2018 %7 07.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Many people use the Internet for health-related information search, which is known to help regulate their emotional state. However, not much is known yet about how Web-based information search together with negative emotional states (ie, threat of cancer diagnosis) relate to preventive medical treatment decisions (ie, colonoscopy intentions). Objective: The aim of this study was to investigate how frequency of health-related Internet use together with perceived threat of a possible (bowel) cancer diagnosis influences intentions to get a colonoscopy. Previous research has shown that people who experience threat preferentially process positive information in an attempt to downregulate the aversive emotional state. The Internet can facilitate this regulatory strategy through allowing self-directed, unrestricted, and thus biased information search. In the context of threat regarding a possible bowel cancer diagnosis, feelings of threat can still be effectively reduced through cancer screening (ie, colonoscopy). We, therefore, predict that in that particular context, feelings of threat should be related to stronger colonoscopy intentions, and that this relationship should be enhanced for people who use the Internet often. Methods: A longitudinal questionnaire study was conducted among healthy participants who were approaching or just entering the bowel cancer risk group (aged 45-55 years). Perceived threat of a possible (bowel) cancer diagnosis, frequency of health-related Internet use, and intentions to have a colonoscopy were assessed at 2 time points (6-month time lag between the 2 measurement points T1 and T2). Multiple regression analyses were conducted to test whether threat and Internet use at T1 together predicted colonoscopy intentions at T2. Results: In line with our predictions, we found that the threat of a possible (bowel) cancer diagnosis interacted with the frequency of Internet use (both T1) to predict colonoscopy intentions (T2; B=.23, standard error [SE]=0.09, P=.01). For people who used the Internet relatively often (+1 SD), the positive relationship between threat and colonoscopy intentions was significantly stronger (B=.56, SE=0.15, P<.001) compared with participants who used the Internet less often (−1 SD; B=.17, SE=0.09, P=.07). This relationship was unique to Web-based (vs other types of) information search and independent of risk factors (eg, body mass index [BMI] and smoking). Conclusions: The results of this study suggest that health-related Internet use can facilitate emotion-regulatory processes. People who feel threatened by a possible (bowel) cancer diagnosis reported stronger colonoscopy intentions, especially when they used the Internet often. We propose that this is because people who experience threat are more likely to search for and process information that allows them to downregulate their aversive emotional state. In the present case of (bowel) cancer prevention, the most effective way to reduce threat is to get screened. %M 29415872 %R 10.2196/jmir.9144 %U http://www.jmir.org/2018/2/e46/ %U https://doi.org/10.2196/jmir.9144 %U http://www.ncbi.nlm.nih.gov/pubmed/29415872 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e424 %T Automatic Classification of Users’ Health Information Need Context: Logistic Regression Analysis of Mouse-Click and Eye-Tracker Data %A Pian,Wenjing %A Khoo,Christopher SG %A Chi,Jianxing %+ College of Communication, Fujian Normal University, Qishan Campus, University Town, Fuzhou, 350117, China, 86 13696889850, islandma@foxmail.com %K information-seeking behavior %K social media %K Internet %K consumer health information %K medical informatics %D 2017 %7 21.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Users searching for health information on the Internet may be searching for their own health issue, searching for someone else’s health issue, or browsing with no particular health issue in mind. Previous research has found that these three categories of users focus on different types of health information. However, most health information websites provide static content for all users. If the three types of user health information need contexts can be identified by the Web application, the search results or information offered to the user can be customized to increase its relevance or usefulness to the user. Objective: The aim of this study was to investigate the possibility of identifying the three user health information contexts (searching for self, searching for others, or browsing with no particular health issue in mind) using just hyperlink clicking behavior; using eye-tracking information; and using a combination of eye-tracking, demographic, and urgency information. Predictive models are developed using multinomial logistic regression. Methods: A total of 74 participants (39 females and 35 males) who were mainly staff and students of a university were asked to browse a health discussion forum, Healthboards.com. An eye tracker recorded their examining (eye fixation) and skimming (quick eye movement) behaviors on 2 types of screens: summary result screen displaying a list of post headers, and detailed post screen. The following three types of predictive models were developed using logistic regression analysis: model 1 used only the time spent in scanning the summary result screen and reading the detailed post screen, which can be determined from the user’s mouse clicks; model 2 used the examining and skimming durations on each screen, recorded by an eye tracker; and model 3 added user demographic and urgency information to model 2. Results: An analysis of variance (ANOVA) analysis found that users’ browsing durations were significantly different for the three health information contexts (P<.001). The logistic regression model 3 was able to predict the user’s type of health information context with a 10-fold cross validation mean accuracy of 84% (62/74), followed by model 2 at 73% (54/74) and model 1 at 71% (52/78). In addition, correlation analysis found that particular browsing durations were highly correlated with users’ age, education level, and the urgency of their information need. Conclusions: A user’s type of health information need context (ie, searching for self, for others, or with no health issue in mind) can be identified with reasonable accuracy using just user mouse clicks that can easily be detected by Web applications. Higher accuracy can be obtained using Google glass or future computing devices with eye tracking function. %M 29269342 %R 10.2196/jmir.8354 %U http://www.jmir.org/2017/12/e424/ %U https://doi.org/10.2196/jmir.8354 %U http://www.ncbi.nlm.nih.gov/pubmed/29269342 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e24 %T How, When and Why People Seek Health Information Online: Qualitative Study in Hong Kong %A Chu,Joanna TW %A Wang,Man Ping %A Shen,Chen %A Viswanath,Kasisomayajula %A Lam,Tai Hing %A Chan,Sophia Siu Chee %+ School of Public Health, The University of Hong Kong, Patrick Manson Building, No 7, Sassoon Road, Hong Kong,, China (Hong Kong), 852 39179287, hrmrlth@hku.hk %K Internet %K information seeking behavior %K consumer health information %K focus groups %D 2017 %7 12.12.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: The Internet has become an established source for health information. The number of individuals using the Internet to search for health information, ranging from healthy lifestyle advice to treatment and diseases, continues to grow. Scholars have emphasized the need to give greater voice and influence to health consumers. Hong Kong, being one of the most technologically advanced and connected cities in the world, has one of the highest Internet penetration rates in the world. Given the dearth of research in an Asian context, Hong Kong is an excellent platform to study individuals’ perceptions (eg, benefits and limitations on seeking health information online and how the information is used) on health information seeking. Objective: The aim of this paper was to study individuals’ perceptions on health information seeking and to document their Internet information–seeking behaviors. Methods: Five focus groups (n=49) were conducted from November 2015 to January 2016 with individuals across different age groups (18 years or above). Focus group contents were audiotaped, transcribed, and analyzed using thematic analysis techniques. Results: Older (55+ years) and less educated respondents were less likely to use the Internet to search for health information. Among individuals who obtained health information via the Internet, regardless of the severity of the health issue, the Internet was always the first source for information. Limited doctor consultation time and barriers to accessing professional health services were the main reasons for using the Internet. Convenience and coverage were regarded as the main advantages, whereas credibility and trustworthiness of health information were noted as limitations. The use of Web-based health information varied among individuals; hence, the implications on the doctor-patient relationship were mixed. Conclusions: The prevalent and increasing use of the Internet for health information seeking suggests the need for health care professionals to understand how it can be optimally utilized to improve health outcomes. Strategies for communicating and disseminating credible health information in a form that users can understand and use are essential. Due to the rapid technological and related behavioral changes, online health information seeking and its effects need to be closely monitored. %M 29233802 %R 10.2196/ijmr.7000 %U http://www.i-jmr.org/2017/2/e24/ %U https://doi.org/10.2196/ijmr.7000 %U http://www.ncbi.nlm.nih.gov/pubmed/29233802 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 4 %P e48 %T Search and Graph Database Technologies for Biomedical Semantic Indexing: Experimental Analysis %A Segura Bedmar,Isabel %A Martínez,Paloma %A Carruana Martín,Adrián %+ LaBDA Group, Department of Computer Science, Universidad Carlos III de Madrid, Avda. Universidad 30, Leganés, 28911, Spain, 34 916245961, isegura@inf.uc3m.es %K information storage and retrieval %K semantic indexing %K Medical Subject Headings %D 2017 %7 01.12.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Biomedical semantic indexing is a very useful support tool for human curators in their efforts for indexing and cataloging the biomedical literature. Objective: The aim of this study was to describe a system to automatically assign Medical Subject Headings (MeSH) to biomedical articles from MEDLINE. Methods: Our approach relies on the assumption that similar documents should be classified by similar MeSH terms. Although previous work has already exploited the document similarity by using a k-nearest neighbors algorithm, we represent documents as document vectors by search engine indexing and then compute the similarity between documents using cosine similarity. Once the most similar documents for a given input document are retrieved, we rank their MeSH terms to choose the most suitable set for the input document. To do this, we define a scoring function that takes into account the frequency of the term into the set of retrieved documents and the similarity between the input document and each retrieved document. In addition, we implement guidelines proposed by human curators to annotate MEDLINE articles; in particular, the heuristic that says if 3 MeSH terms are proposed to classify an article and they share the same ancestor, they should be replaced by this ancestor. The representation of the MeSH thesaurus as a graph database allows us to employ graph search algorithms to quickly and easily capture hierarchical relationships such as the lowest common ancestor between terms. Results: Our experiments show promising results with an F1 of 69% on the test dataset. Conclusions: To the best of our knowledge, this is the first work that combines search and graph database technologies for the task of biomedical semantic indexing. Due to its horizontal scalability, ElasticSearch becomes a real solution to index large collections of documents (such as the bibliographic database MEDLINE). Moreover, the use of graph search algorithms for accessing MeSH information could provide a support tool for cataloging MEDLINE abstracts in real time. %M 29196280 %R 10.2196/medinform.7059 %U http://medinform.jmir.org/2017/4/e48/ %U https://doi.org/10.2196/medinform.7059 %U http://www.ncbi.nlm.nih.gov/pubmed/29196280 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e86 %T Health Information–Seeking Patterns of the General Public and Indications for Disease Surveillance: Register-Based Study Using Lyme Disease %A Pesälä,Samuli %A Virtanen,Mikko J %A Sane,Jussi %A Mustonen,Pekka %A Kaila,Minna %A Helve,Otto %+ University of Helsinki, Tukholmankatu 8 B, Helsinki, 00029, Finland, 358 400205955, samuli.pesala@helsinki.fi %K search engine %K evidence-based medicine %K medical informatics %K information systems %K communications media %K Lyme disease %K infodemiology %K infoveillance %K surveillance %D 2017 %7 06.11.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: People using the Internet to find information on health issues, such as specific diseases, usually start their search from a general search engine, for example, Google. Internet searches such as these may yield results and data of questionable quality and reliability. Health Library is a free-of-charge medical portal on the Internet providing medical information for the general public. Physician’s Databases, an Internet evidence-based medicine source, provides medical information for health care professionals (HCPs) to support their clinical practice. Both databases are available throughout Finland, but the latter is used only by health professionals and pharmacies. Little is known about how the general public seeks medical information from medical sources on the Internet, how this behavior differs from HCPs’ queries, and what causes possible differences in behavior. Objective: The aim of our study was to evaluate how the general public’s and HCPs’ information-seeking trends from Internet medical databases differ seasonally and temporally. In addition, we aimed to evaluate whether the general public’s information-seeking trends could be utilized for disease surveillance and whether media coverage could affect these seeking trends. Methods: Lyme disease, serving as a well-defined disease model with distinct seasonal variation, was chosen as a case study. Two Internet medical databases, Health Library and Physician’s Databases, were used. We compared the general public’s article openings on Lyme disease from Health Library to HCPs’ article openings on Lyme disease from Physician’s Databases seasonally across Finland from 2011 to 2015. Additionally, media publications related to Lyme disease were searched from the largest and most popular media websites in Finland. Results: Both databases, Health Library and Physician’s Databases, show visually similar patterns in temporal variations of article openings on Lyme disease in Finland from 2011 to 2015. However, Health Library openings show not only an increasing trend over time but also greater fluctuations, especially during peak opening seasons. Outside these seasons, publications in the media coincide with Health Library article openings only occasionally. Conclusions: Lyme disease–related information-seeking behaviors between the general public and HCPs from Internet medical portals share similar temporal variations, which is consistent with the trend seen in epidemiological data. Therefore, the general public’s article openings could be used as a supplementary source of information for disease surveillance. The fluctuations in article openings appeared stronger among the general public, thus, suggesting that different factors such as media coverage, affect the information-seeking behaviors of the public versus professionals. However, media coverage may also have an influence on HCPs. Not every publication was associated with an increase in openings, but the higher the media coverage by some publications, the higher the general public’s access to Health Library. %M 29109071 %R 10.2196/publichealth.8306 %U http://publichealth.jmir.org/2017/4/e86/ %U https://doi.org/10.2196/publichealth.8306 %U http://www.ncbi.nlm.nih.gov/pubmed/29109071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e340 %T What Clinical Information Is Valuable to Doctors Using Mobile Electronic Medical Records and When? %A Kim,Junetae %A Lee,Yura %A Lim,Sanghee %A Kim,Jeong Hoon %A Lee,Byungtae %A Lee,Jae-Ho %+ Department of Biomedical Informatics, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic Of Korea, 82 23010 3350, rufiji@gmail.com %K mobile health %K electronic medical records %K clinical information %K rounding %K timeliness %K accessibility %K smartphone %D 2017 %7 18.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been a lack of understanding on what types of specific clinical information are most valuable for doctors to access through mobile-based electronic medical records (m-EMRs) and when they access such information. Furthermore, it has not been clearly discussed why the value of such information is high. Objective: The goal of this study was to investigate the types of clinical information that are most valuable to doctors to access through an m-EMR and when such information is accessed. Methods: Since 2010, an m-EMR has been used in a tertiary hospital in Seoul, South Korea. The usage logs of the m-EMR by doctors were gathered from March to December 2015. Descriptive analyses were conducted to explore the overall usage patterns of the m-EMR. To assess the value of the clinical information provided, the usage patterns of both the m-EMR and a hospital information system (HIS) were compared on an hourly basis. The peak usage times of the m-EMR were defined as continuous intervals having normalized usage values that are greater than 0.5. The usage logs were processed as an indicator representing specific clinical information using factor analysis. Random intercept logistic regression was used to explore the type of clinical information that is frequently accessed during the peak usage times. Results: A total of 524,929 usage logs from 653 doctors (229 professors, 161 fellows, and 263 residents; mean age: 37.55 years; males: 415 [63.6%]) were analyzed. The highest average number of m-EMR usage logs (897) was by medical residents, whereas the lowest (292) was by surgical residents. The usage amount for three menus, namely inpatient list (47,096), lab results (38,508), and investigation list (25,336), accounted for 60.1% of the peak time usage. The HIS was used most frequently during regular hours (9:00 AM to 5:00 PM). The peak usage time of the m-EMR was early in the morning (6:00 AM to 10:00 AM), and the use of the m-EMR from early evening (5:00 PM) to midnight was higher than during regular business hours. Four factors representing the types of clinical information were extracted through factor analysis. Factors related to patient investigation status and patient conditions were associated with the peak usage times of the m-EMR (P<.01). Conclusions: Access to information regarding patient investigation status and patient conditions is crucial for decision making during morning activities, including ward rounds. The m-EMRs allow doctors to maintain the continuity of their clinical information regardless of the time and location constraints. Thus, m-EMRs will best evolve in a manner that enhances the accessibility of clinical information helpful to the decision-making process under such constraints. %M 29046269 %R 10.2196/jmir.8128 %U http://www.jmir.org/2017/10/e340/ %U https://doi.org/10.2196/jmir.8128 %U http://www.ncbi.nlm.nih.gov/pubmed/29046269 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e352 %T Consumer Health-Related Activities on Social Media: Exploratory Study %A Benetoli,Arcelio %A Chen,Timothy F %A Aslani,Parisa %+ Faculty of Pharmacy, The University of Sydney, Pharmacy & Bank Building (A15), Science Road, The University of Sydney, Sydney,, Australia, 61 2 9351 7110, arceliobenetoli@hotmail.com %K social media %K social networking sites %K Facebook %K YouTube %K Wikipedia %K Twitter %K health %K consumers %K patients %K focus groups %D 2017 %7 13.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Although a number of studies have investigated how consumers use social media for health-related purposes, there is a paucity of studies in the Australian context. Objective: This study aimed to explore how Australian consumers used social media for health-related purposes, specifically how they identified social media platforms, which were used, and which health-related activities commonly took place. Methods: A total of 5 focus groups (n=36 participants), each lasting 60 to 90 minutes, were conducted in the Sydney metropolitan area. The group discussions were audiorecorded and transcribed verbatim. The transcripts were coded line-by-line and thematically analyzed. Results: Participants used general search engines to locate health-related social media platforms. They accessed a wide range of social media on a daily basis, using several electronic devices (in particular, mobile phones). Although privacy was a concern, it did not prevent consumers from fully engaging in social media for health-related purposes. Blogs were used to learn from other people’s experiences with the same condition. Facebook allowed consumers to follow health-related pages and to participate in disease-specific group discussions. Wikipedia was used for factual information about diseases and treatments. YouTube was accessed to learn about medical procedures such as surgery. No participant reported editing or contributing to Wikipedia or posting YouTube videos related to health topics. Twitter was rarely used for health-related purposes. Social media allowed consumers to obtain and provide disease and treatment-related information and social and emotional support for those living with the same condition. Most considered their participation as observational, but some also contributed (eg, responded to people’s questions). Conclusions: Participants used a wide range of social media for health-related purposes. Medical information exchange (eg, disease and treatment) and social and emotional support were the cornerstones of their online activities. Social media appears to be used as a key tool to support disease self-management. %M 29030326 %R 10.2196/jmir.7656 %U http://www.jmir.org/2017/10/e352/ %U https://doi.org/10.2196/jmir.7656 %U http://www.ncbi.nlm.nih.gov/pubmed/29030326 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e335 %T Comparison of Health Information Technology Use Between American Adults With and Without Chronic Health Conditions: Findings From The National Health Interview Survey 2012 %A Zhang,Yan %A Lauche,Romy %A Sibbritt,David %A Olaniran,Bolanle %A Cook,Ronald %A Adams,Jon %+ Division of Integrative Medicine, Department of Family and Community Medicine, School of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street MS8143, Lubbock, TX, 79430, United States, 1 8067436056, yan.zhang@ttuhsc.edu %K health information technology %K chronic illness %D 2017 %7 05.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Health information technology (HIT) is utilized by people with different chronic conditions such as diabetes and hypertension. However, there has been no comparison of HIT use between persons without a chronic condition, with one chronic condition, and multiple (≥2) chronic conditions (MCCs). Objective: The aim of the study was to assess the difference in HIT use between persons without a chronic condition, with one chronic condition, and with MCCs, to describe the characteristics of HIT use among those with chronic conditions and to identify the predictors of HIT use of the persons with one chronic condition and MCCs. Methods: A secondary data analysis was conducted in spring 2017 using the National Health Interview Survey (NHIS) 2012 Family Core and Sample Adult Core datasets that yielded 34,525 respondents aged 18 years and older. Measures included overall HIT use (ie, any use of the following five HIT on the Internet: seeking health information, ordering prescription, making appointment, emailing health provider, and using health chat groups), as well as sociodemographic and health-related characteristics. Sociodemographic and health characteristics were compared between HIT users and nonusers among those who reported having at least one chronic condition using chi-square tests. Independent predictors of HIT use were identified using multiple logistic regression analyses for those with one chronic condition, with MCCs, and without a chronic condition. Analyses were weighted and performed at significance level of .005. Results: In 2012, adults with one health chronic condition (raw count 4147/8551, weighted percentage 48.54%) was significantly higher than among those with MCCs (3816/9637, 39.55%) and those with none of chronic condition (7254/16,337, 44.40%, P<.001). Seeking health information was the most prevalent HIT use. Chi-square tests revealed that among adults with chronic conditions, those who used HIT were significantly different from their counterpart peers who did not use HIT in terms of sociodemographic and health characteristics (P<.001). Overall, the significant factors related to HIT use were similar among the adults with one chronic condition, with MCCs, or without a chronic condition: younger age, female sex, non-Hispanic white, higher education level, and higher income level were shown to be positively related to the HIT use. Conclusions: This study provides a snapshot of HIT use among those with chronic conditions and potential factors related to such use. Clinical care and public health communication efforts attempting to leverage more HIT use should acknowledge differential HIT usage as identified in this study to better address communication inequalities and persistent disparities in socioeconomic status. %M 28982644 %R 10.2196/jmir.6989 %U http://www.jmir.org/2017/10/e335/ %U https://doi.org/10.2196/jmir.6989 %U http://www.ncbi.nlm.nih.gov/pubmed/28982644 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e64 %T Effects of the Ambient Fine Particulate Matter on Public Awareness of Lung Cancer Risk in China: Evidence from the Internet-Based Big Data Platform %A Yang,Hongxi %A Li,Shu %A Sun,Li %A Zhang,Xinyu %A Hou,Jie %A Wang,Yaogang %+ School of Public Health, Tianjin Medical University, No 22, Qixiangtai Road, Heping District, Tianjin, 300070, China, 86 13820046130, wyg@tmu.edu.cn %K lung cancer %K risk factors %K particulate matter %K PM2.5 %K Baidu Index %K information seeking behavior %K public awareness %K China %D 2017 %7 03.10.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In October 2013, the International Agency for Research on Cancer classified the particulate matter from outdoor air pollution as a group 1 carcinogen and declared that particulate matter can cause lung cancer. Fine particular matter (PM2.5) pollution is becoming a serious public health concern in urban areas of China. It is essential to emphasize the importance of the public’s awareness and knowledge of modifiable risk factors of lung cancer for prevention. Objective: The objective of our study was to explore the public’s awareness of the association of PM2.5 with lung cancer risk in China by analyzing the relationship between the daily PM2.5 concentration and searches for the term “lung cancer” on an Internet big data platform, Baidu. Methods: We collected daily PM2.5 concentration data and daily Baidu Index data in 31 Chinese capital cities from January 1, 2014 to December 31, 2016. We used Spearman correlation analysis to explore correlations between the daily Baidu Index for lung cancer searches and the daily average PM2.5 concentration. Granger causality test was used to analyze the causal relationship between the 2 time-series variables. Results: In 23 of the 31 cities, the pairwise correlation coefficients (Spearman rho) between the daily Baidu Index for lung cancer searches and the daily average PM2.5 concentration were positive and statistically significant (P<.05). However, the correlation between the daily Baidu Index for lung cancer searches and the daily average PM2.5 concentration was poor (all r2s<.1). Results of Granger causality testing illustrated that there was no unidirectional causality from the daily PM2.5 concentration to the daily Baidu Index for lung cancer searches, which was statistically significant at the 5% level for each city. Conclusions: The daily average PM2.5 concentration had a weak positive impact on the daily search interest for lung cancer on the Baidu search engine. Well-designed awareness campaigns are needed to enhance the general public’s awareness of the association of PM2.5 with lung cancer risk, to lead the public to seek more information about PM2.5 and its hazards, and to cope with their environment and its risks appropriately. %M 28974484 %R 10.2196/publichealth.8078 %U https://publichealth.jmir.org/2017/4/e64/ %U https://doi.org/10.2196/publichealth.8078 %U http://www.ncbi.nlm.nih.gov/pubmed/28974484 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 4 %P e33 %T Expert Search Strategies: The Information Retrieval Practices of Healthcare Information Professionals %A Russell-Rose,Tony %A Chamberlain,Jon %+ UXLabs Ltd, 3000 Cathedral Hill, Guildford, GU2 7YB, United Kingdom, 44 7779 936191, tgr@uxlabs.co.uk %K review %K surveys and questionnaires %K search engine %K information management %K information systems %D 2017 %7 02.10.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Healthcare information professionals play a key role in closing the knowledge gap between medical research and clinical practice. Their work involves meticulous searching of literature databases using complex search strategies that can consist of hundreds of keywords, operators, and ontology terms. This process is prone to error and can lead to inefficiency and bias if performed incorrectly. Objective: The aim of this study was to investigate the search behavior of healthcare information professionals, uncovering their needs, goals, and requirements for information retrieval systems. Methods: A survey was distributed to healthcare information professionals via professional association email discussion lists. It investigated the search tasks they undertake, their techniques for search strategy formulation, their approaches to evaluating search results, and their preferred functionality for searching library-style databases. The popular literature search system PubMed was then evaluated to determine the extent to which their needs were met. Results: The 107 respondents indicated that their information retrieval process relied on the use of complex, repeatable, and transparent search strategies. On average it took 60 minutes to formulate a search strategy, with a search task taking 4 hours and consisting of 15 strategy lines. Respondents reviewed a median of 175 results per search task, far more than they would ideally like (100). The most desired features of a search system were merging search queries and combining search results. Conclusions: Healthcare information professionals routinely address some of the most challenging information retrieval problems of any profession. However, their needs are not fully supported by current literature search systems and there is demand for improved functionality, in particular regarding the development and management of search strategies. %M 28970190 %R 10.2196/medinform.7680 %U https://medinform.jmir.org/2017/4/e33/ %U https://doi.org/10.2196/medinform.7680 %U http://www.ncbi.nlm.nih.gov/pubmed/28970190 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e17 %T Internet Usage by Parents Prior to Seeking Care at a Pediatric Emergency Department: Observational Study %A Shroff,Purvi L %A Hayes,Rebecca W %A Padmanabhan,Pradeep %A Stevenson,Michelle D %+ Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, 571 S. Floyd St., Ste. 300, Louisville, KY, 40202, United States, 1 502 629 7212, michelle.stevenson@louisville.edu %K Internet %K emergency department %K decision making %D 2017 %7 28.09.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: Little is known about how parents utilize medical information on the Internet prior to an emergency department (ED) visit. Objective: The objective of the study was to determine the proportion of parents who accessed the Internet for medical information related to their child’s illness in the 24 hours prior to an ED visit (IPED), to identify the websites used, and to understand how the content contributed to the decision to visit the ED. Methods: A 40-question interview was conducted with parents presenting to an ED within a freestanding children’s hospital. If parents reported IPED, the number and names of websites were documented. Parents indicated the helpfulness of Web-based content using a 100-mm visual analog scale and the degree to which it contributed to the decision to visit the ED using 5-point Likert-type responses. Results: About 11.8 % (31/262) reported IPED (95% CI 7.3-5.3). Parents who reported IPED were more likely to have at least some college education (P=.04), higher annual household income (P=.001), and older children (P=.04) than those who did not report IPED. About 35% (11/31) could not name any websites used. Mean level of helpfulness of Web-based content was 62 mm (standard deviation, SD=25 mm). After Internet use, some parents (29%, 9/31) were more certain they needed to visit the ED, whereas 19% (6/31) were less certain. A majority (87%, 195/224) of parents who used the Internet stated that they would be somewhat likely or very likely to visit a website recommended by a physician. Conclusions: Nearly 1 out of 8 parents presenting to an urban pediatric ED reported using the Internet in the 24 hours prior to the ED visit. Among privately insured, at least one in 5 parents reported using the Internet prior to visiting the ED. Web-based medical information often influences decision making regarding ED utilization. Pediatric providers should provide parents with recommendations for high-quality sources of health information available on the Internet. %M 28958988 %R 10.2196/ijmr.5075 %U http://www.i-jmr.org/2017/2/e17/ %U https://doi.org/10.2196/ijmr.5075 %U http://www.ncbi.nlm.nih.gov/pubmed/28958988 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 2 %N 2 %P e23 %T Mutual Involvement in Families With Type 2 Diabetes Through Web-Based Health Care Solutions: Quantitative Survey Study of Family Preferences, Challenges, and Potentials %A Vitger,Tobias %A Langberg,Henning %A Grabowski,Dan %+ Health Promotion Research, Steno Diabetes Center Copenhagen, Niels Steensens Vej 8, Gentofte, DK-2820, Denmark, 45 40887966, tobias.vitger@regionh.dk %K online %K health information %K diabetes %K support %K family %D 2017 %7 27.09.2017 %9 Original Paper %J JMIR Diabetes %G English %X Background: Type 2 diabetes (T2D) is a prevalent chronic disease that affects not just patients but entire families. Both the patient and the rest of the family may benefit from gaining knowledge about the disease and from supportive interfamilial interaction. The Internet is becoming a widely-used resource for health information, so a Web-based solution could potentially promote awareness and knowledge on how to manage T2D as a family, while also providing support for the family. Objective: We aim to assess the usage of online diabetes information by patients with T2D and their relatives, and explore the families’ needs and preferences regarding online information on diabetes. Methods: A quantitative self-reported questionnaire survey was performed with Danish families that had at least one family member diagnosed with T2D. The survey consisted of 36 closed questions on demographics, usage of the Internet, preferences in the source of information, interest in online information on six problem domains within family life related to T2D, preferences towards the delivery format of online information, and peer-to-peer communication. Two open-ended questions were also included to elicit any additional comments or suggestions about improving online information on T2D regarding family life. Results: Fifty participants from 22 families with T2D answered the questionnaire individually. Relatives (25/28, 89%) and patients (22/22, 100%) indicated that information on T2D is relevant for them, while indicating that the Internet is the first or second preferred source when in need of information on T2D (25/28, 89% vs 21/22, 95%). Only a minority of the participants indicated that they had searched the Internet to gain knowledge on T2D regarding family life (9/28, 32% vs 10/22, 46%). Also, patients were more likely to have used the Internet to gain information on T2D (P=.027). Both groups indicated a preference for watching videos or reading about T2D in relation to family life while a minority of the participants indicated an interest in peer-to-peer communication. Regarding the six problem domains, the domains Support, Knowledge, and Everyday Life were slightly more popular. These three domains were considered interesting by at least 79% (22/28) and 73% (16/22) of the relatives and patients respectively, while the domains Communication, Worries, and Roles were considered interesting by at least 46% (20/28) and 50% (11/22). Conclusions: Despite an interest in online information on T2D, there appears to be an unsatisfied need for more supportive online information on T2D aimed at Danish families with T2D. Based on family preferences, online information should focus on the six problem domains and be presented through text and videos by health care practitioners and peers. Peer-to-peer communication elements may be beneficial, but are only expected to be used by a very limited number of families. %M 30291067 %R 10.2196/diabetes.7456 %U http://diabetes.jmir.org/2017/2/e23/ %U https://doi.org/10.2196/diabetes.7456 %U http://www.ncbi.nlm.nih.gov/pubmed/30291067 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e240 %T Listening to Communities: Mixed-Method Study of the Engagement of Disadvantaged Mothers and Pregnant Women With Digital Health Technologies %A Guendelman,Sylvia %A Broderick,Andrew %A Mlo,Hmellisa %A Gemmill,Alison %A Lindeman,David %+ Maternal and Child Health, School of Public Health, University of California, Berkeley, 207J University Hall, 2199 Addison St, Berkeley, CA, 94720-7360, United States, 1 510 642 1512, sylviag@berkeley.edu %K digital divide %K health information management %K consumer health information %K pregnant women %K mothers %D 2017 %7 05.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: US health care providers are increasingly demanding patient engagement with digital health technologies to enroll in care, access personal health information, communicate with providers, and monitor their own health. Such engagement may be difficult for disadvantaged populations who may have limited health literacy, time constraints, or competing priorities. Objective: We aimed to understand the extent of adoption and use of digital health tools and to identify key perceived psychological motivators of technology use among disadvantaged first-time pregnant women and mothers of young children. Methods: We recruited women from health organizations serving low-income communities in the Midwest and on the East and West coasts. A total of 92 women participated in 14 focus groups. During each session, we administered worksheets that measured 3 utilization outcomes: the number of recent Web-based health-seeking activities, current use of digital health-management practices (eg, accessing personal health information, communicating with providers, and scheduling appointments), and potential adoption of digital health-management tools among low users or nonusers. Responses to the worksheets and to a pre-focus group survey on demographics, technology access, and motivators of use were examined to create user profiles. Separate regression models identified the motivators (eHealth literacy, internal health orientation, and trust in digital information) associated with these outcomes. Qualitative data were incorporated to illustrate the worksheet responses. Results: Whereas 97% of the participants reported that they had searched for health information on the Internet in the past year, 42% did not engage in digital health-management practices. Among the low users and nonusers, 49% expressed interest in future adoption of digital health tools. Web-based health information-seeking activities were associated with digital health-management practices (P<.001). When controlling for covariates, eHealth literacy was positively correlated with the number of Web-based health-seeking activities (beta=.03, 95% CI 0.00-0.07). However, an internal health orientation was a much stronger correlate of digital health-management practices (beta=.13, 95% CI 0.02-0.24), whereas trust in digital information increased the odds of potential adoption (vs no adoption) in adjusted models (OR 5.21, 95% CI 0.84-32.53). Demographic characteristics were not important drivers of digital health use and few differences distinguished use among mothers and pregnant women. Conclusions: Seeking health information on the Internet may be an important gateway toward engaging in digital health-management practices. Notably, different consumer motivators influence digital health tool use. The relative contributions of each must be explored to design tools and interventions that enhance competencies for the management of self and child health among disadvantaged mothers and pregnant women. Unless we address disparities in digital health tool use, benefits from their use will accrue predominantly to individuals with the resources and skills to use technology effectively. %M 28679489 %R 10.2196/jmir.7736 %U http://www.jmir.org/2017/7/e240/ %U https://doi.org/10.2196/jmir.7736 %U http://www.ncbi.nlm.nih.gov/pubmed/28679489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e235 %T Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration %A Nightingale,Ruth %A Hall,Andrew %A Gelder,Carole %A Friedl,Simone %A Brennan,Eileen %A Swallow,Veronica %+ Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London,, United Kingdom, 44 7825 098844, ruth.nightingale@gosh.nhs.uk %K child %K adolescent %K long-term condition %K chronic condition %K self-management %K self-care %K mobile apps %K apps %K qualitative %D 2017 %7 04.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed. Objective: To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app. Methods: Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories. Results: Of the 27 interviews, 19 (70%) interviews were individual and 8 (30%) were joint—5 out of 8 (63%) joint interviews were with a child or young person and their parent, 1 out of 8 (13%) were with a child and both parents, and 2 out of 8 (25%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3) Suggestions for a digital care-management app. Reported gaps included the fact that current online information is not usually appropriate for children as it is “dry” and “boring,” could be “scary,” and was either hard to understand or not relevant to individuals’ circumstances. For children, searching online was much less accessible than using a professional-endorsed mobile app. Children also reported difficulty explaining their condition to others, maintaining treatment adherence, coping with feeling isolated, and with trying to live a “normal” life. There was recognition that a developmentally appropriate, CKD-specific app could support the process of explaining the condition to healthy peers, reducing isolation, adhering to care-management plans, and living a “normal” life. Participants recommended a range of media and content to include in a tailored, interactive, age- and developmentally appropriate app. For example, the user would be able to enter their age and diagnosis so that only age-appropriate and condition-specific content is displayed. Conclusions: Future development of a digital app that meets the identified information and support needs and preferences of children with CKD will maximize its utility, thereby augmenting CKD caregiving and optimizing outcomes. %M 28676470 %R 10.2196/jmir.7760 %U http://www.jmir.org/2017/7/e235/ %U https://doi.org/10.2196/jmir.7760 %U http://www.ncbi.nlm.nih.gov/pubmed/28676470 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e216 %T What Predicts Online Health Information-Seeking Behavior Among Egyptian Adults? A Cross-Sectional Study %A Ghweeba,Mayada %A Lindenmeyer,Antje %A Shishi,Sobhi %A Abbas,Mostafa %A Waheed,Amani %A Amer,Shaymaa %+ Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 0 121 4145390, a.lindenmeyer@bham.ac.uk %K Internet %K information-seeking behavior %K computer literacy %K surveys and questionnaires %K Egypt %D 2017 %7 22.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Over the last decade, the Internet has become an important source of health-related information for a wide range of users worldwide. Yet, little is known about the personal characteristics of Egyptian Internet users who search for online health information (OHI). Objective: The aim of the study was to identify the personal characteristics of Egyptian OHI seekers and to determine any associations between their personal characteristics and their health information-seeking behavior. Methods:  This cross-sectional questionnaire study was conducted from June to October 2015. A Web-based questionnaire was sent to Egyptian users aged 18 years and older (N=1400) of a popular Arabic-language health information website. The questionnaire included (1) demographic characteristics; (2) self-reported general health status; and (3) OHI-seeking behavior that included frequency of use, different topics sought, and self-reported impact of obtained OHI on health behaviors. Data were analyzed using descriptive statistics and multiple regression analysis. Results: A total of 490 participants completed the electronic questionnaire with a response rate equivalent to 35.0% (490/1400). Regarding personal characteristics, 57.1% (280/490) of participants were females, 63.4% (311/490) had a university level qualification, and 37.1% (182/490) had a chronic health problem. The most commonly sought OHI by the participants was nutrition-related. Results of the multiple regression analysis showed that 31.0% of the variance in frequency of seeking OHI among Egyptian adults can be predicted by personal characteristics. Participants who sought OHI more frequently were likely to be female, of younger age, had higher education levels, and good self-reported general health. Conclusions: Our results provide insights into personal characteristics and OHI-seeking behaviors of Egyptian OHI users. This will contribute to better recognize their needs, highlight ways to increase the availability of appropriate OHI, and may lead to the provision of tools allowing Egyptian OHI users to navigate to the highest-quality health information. %M 28642216 %R 10.2196/jmir.6855 %U http://www.jmir.org/2017/6/e216/ %U https://doi.org/10.2196/jmir.6855 %U http://www.ncbi.nlm.nih.gov/pubmed/28642216 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e220 %T Classifying Chinese Questions Related to Health Care Posted by Consumers Via the Internet %A Guo,Haihong %A Na,Xu %A Hou,Li %A Li,Jiao %+ Institute of Medical Information & Library, Chinese Academy of Medical Sciences, 3rd Yabao Road Chaoyang District, Beijing, 100020, China, 86 01052328740, li.jiao@imicams.ac.cn %K classification %K natural language processing %K hypertension %K consumer health information %D 2017 %7 20.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: In question answering (QA) system development, question classification is crucial for identifying information needs and improving the accuracy of returned answers. Although the questions are domain-specific, they are asked by non-professionals, making the question classification task more challenging. Objective: This study aimed to classify health care–related questions posted by the general public (Chinese speakers) on the Internet. Methods: A topic-based classification schema for health-related questions was built by manually annotating randomly selected questions. The Kappa statistic was used to measure the interrater reliability of multiple annotation results. Using the above corpus, we developed a machine-learning method to automatically classify these questions into one of the following six classes: Condition Management, Healthy Lifestyle, Diagnosis, Health Provider Choice, Treatment, and Epidemiology. Results: The consumer health question schema was developed with a four-hierarchical-level of specificity, comprising 48 quaternary categories and 35 annotation rules. The 2000 sample questions were coded with 2000 major codes and 607 minor codes. Using natural language processing techniques, we expressed the Chinese questions as a set of lexical, grammatical, and semantic features. Furthermore, the effective features were selected to improve the question classification performance. From the 6-category classification results, we achieved an average precision of 91.41%, recall of 89.62%, and F1 score of 90.24%. Conclusions: In this study, we developed an automatic method to classify questions related to Chinese health care posted by the general public. It enables Artificial Intelligence (AI) agents to understand Internet users’ information needs on health care. %M 28634156 %R 10.2196/jmir.7156 %U http://www.jmir.org/2017/6/e220/ %U https://doi.org/10.2196/jmir.7156 %U http://www.ncbi.nlm.nih.gov/pubmed/28634156 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 2 %P e39 %T Understanding Health Information Seeking on the Internet Among Sexual Minority People: Cross-Sectional Analysis From the Health Information National Trends Survey %A Jabson,Jennifer M %A Patterson,Joanne G %A Kamen,Charles %+ University of Tennessee, Department of Public Health, 390 HPER, 1914 Andy Holt Ave, Knoxville, TN, 37996, United States, 1 865 974 0796, jjabson@utk.edu %K sexual orientation %K Internet-based health information seeking %K internet access %K sexual minority %K homosexuality %K bisexuality %D 2017 %7 19.06.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Individuals who face barriers to health care are more likely to access the Internet to seek health information. Pervasive stigma and heterosexism in the health care setting are barriers to health care for sexual minority people (SMP, ie, lesbian, gay, and bisexual people); therefore, SMP may be more likely to use the Internet as a source of health information compared to heterosexual people. Objective: Currently, there is a dearth of published empirical evidence concerning health information seeking on the Internet among SMP; the current project addresses this gap. Methods: Data from the 2015 Health Information National Trends Survey Food and Drug Administration Cycle were used to describe and summarize health information seeking among SMP (n=105) and heterosexual people (n=3405). Results: Almost all of the SMP in this sample reported having access to the Internet (92.4%, 97/105). SMP were equally as likely as heterosexual people to seek health information on the Internet (adjusted odds ratio [aOR] 0.94, 95% CI 0.56-1.66) and to report incidental exposure to health information online (aOR 1.02, 95% CI 0.66-1.60). SMP were 58% more likely to watch a health-related video on YouTube than heterosexual people (aOR 1.58, 95% CI 1.00-2.47). Incidental exposure to health information was associated with seeking health information for oneself (aOR 3.87, 95% CI 1.16-14.13) and for someone else (aOR 6.30, 95% CI 2.40-17.82) among SMP. Conclusions: SMP access the Internet at high rates and seek out health information online. Their incidental exposure could be associated with seeking information for self or others. This suggests that online interventions could be valuable for delivering or promoting health information for SMP. %M 28630036 %R 10.2196/publichealth.7526 %U http://publichealth.jmir.org/2017/2/e39/ %U https://doi.org/10.2196/publichealth.7526 %U http://www.ncbi.nlm.nih.gov/pubmed/28630036 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e210 %T Dr Google Is Here to Stay but Health Care Professionals Are Still Valued: An Analysis of Health Care Consumers’ Internet Navigation Support Preferences %A Lee,Kenneth %A Hoti,Kreshnik %A Hughes,Jeffery David %A Emmerton,Lynne %+ Division of Pharmacy, School of Medicine, University of Tasmania, Private Bag 26, Hobart, 7001, Australia, 61 362262191, kenneth.lee@utas.edu.au %K health care %K information seeking behavior %K Internet %K chronic disease %K patients %K surveys %D 2017 %7 14.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet offers great opportunities for consumers to be informed about their health. However, concerns have been raised regarding its impact on the traditional health consumer-health professional relationship. Our recent survey of 400 Australian adults identified that over half of consumers required some form of navigational support in locating appropriate Web-based health information. We propose that support provided by health professionals would be preferred by consumers; this preference is regardless of whether consumers have a need for navigational support. Secondary analysis of the survey dataset is presented here to quantify consumer-reported support preferences and barriers when navigating Web-based health information. Objective: We aimed to quantitatively identify consumers’ support preferences for locating Web-based health information and their barriers when navigating Web-based health information. We also aimed to compare such preferences and barriers between consumers identified as needing and not needing support when locating Web-based health information. Methods: Chi-square (χ2) tests identified whether each listed support preference differed between subgroups of consumers classified as needing (n=205, 51.3%) or not needing (n=195, 48.8%) navigational support; degree of association, via phi coefficient (φ) tests, were also considered to ascertain the likely practical significance of any differences. This was repeated for each listed barrier. Free-text responses regarding additional support preferences were descriptively analyzed and compared with the quantitative findings to provide a richer understanding of desired support for health information searches. Results: Of the 400 respondents, the most preferred mode of navigational support was involvement of health professionals; this was reported by participants identified as needing and not needing navigational support. While there was a significant difference between groups, the degree of association was small (χ21 [N=400]=13.2; P<.001; φ=.18). Qualitative data from the free-text responses supported consumers’ desire for health professional involvement. The two most commonly reported barriers when navigating desired Web-based health information were (1) volume of available information and (2) inconsistency of information between sources; these were reported by participants with and without a need for navigational support. While participants identified with a need for navigational support were more likely to report volume (χ21 [N=387]= 4.40; P=.04; φ=.11) and inconsistency of information (χ21 [N=387]= 16.10, P<.001, φ=.20) as barriers, the degrees of association were small to moderate. Conclusions: Despite concerns in the literature that the popularity of the Internet could compromise the health consumer-health professional relationship, our findings suggest the contrary. Our findings showed that health professionals were found to be the most commonly preferred mode of navigational support, even among consumers classified as not needing navigational support. Further research into how health professionals could assist consumers with Web-based health information seeking could strengthen the health consumer-health professional relationship amidst the growing use of “Dr Google.” %M 28615156 %R 10.2196/jmir.7489 %U http://www.jmir.org/2017/6/e210/ %U https://doi.org/10.2196/jmir.7489 %U http://www.ncbi.nlm.nih.gov/pubmed/28615156 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e202 %T Web Use for Symptom Appraisal of Physical Health Conditions: A Systematic Review %A Mueller,Julia %A Jay,Caroline %A Harper,Simon %A Davies,Alan %A Vega,Julio %A Todd,Chris %+ School of Health Sciences, University of Manchester, Kilburn Building, LF1, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1612756239, julia.mueller@manchester.ac.uk %K Online health information %K health information seeking %K Internet %K symptom appraisal %K Web search %K search strategies %D 2017 %7 13.06.2017 %9 Review %J J Med Internet Res %G English %X Background: The Web has become an important information source for appraising symptoms. We need to understand the role it currently plays in help seeking and symptom evaluation to leverage its potential to support health care delivery. Objective: The aim was to systematically review the literature currently available on Web use for symptom appraisal. Methods: We searched PubMed, EMBASE, PsycINFO, ACM Digital Library, SCOPUS, and Web of Science for any empirical studies that addressed the use of the Web by lay people to evaluate symptoms for physical conditions. Articles were excluded if they did not meet minimum quality criteria. Study findings were synthesized using a thematic approach. Results: A total of 32 studies were included. Study designs included cross-sectional surveys, qualitative studies, experimental studies, and studies involving website/search engine usage data. Approximately 35% of adults engage in Web use for symptom appraisal, but this proportion varies between 23% and 75% depending on sociodemographic and disease-related factors. Most searches were symptom-based rather than condition-based. Users viewed only the top search results and interacted more with results that mentioned serious conditions. Web use for symptom appraisal appears to impact on the decision to present to health services, communication with health professionals, and anxiety. Conclusions: Web use for symptom appraisal has the potential to influence the timing of help seeking for symptoms and the communication between patients and health care professionals during consultations. However, studies lack suitable comparison groups as well as follow-up of participants over time to determine whether Web use results in health care utilization and diagnosis. Future research should involve longitudinal follow-up so that we can weigh the benefits of Web use for symptom appraisal (eg, reductions in delays to diagnosis) against the disadvantages (eg, unnecessary anxiety and health care use) and relate these to health care costs. %M 28611017 %R 10.2196/jmir.6755 %U http://www.jmir.org/2017/6/e202/ %U https://doi.org/10.2196/jmir.6755 %U http://www.ncbi.nlm.nih.gov/pubmed/28611017 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e189 %T The Role of Web-Based Health Information in Help-Seeking Behavior Prior to a Diagnosis of Lung Cancer: A Mixed-Methods Study %A Mueller,Julia %A Jay,Caroline %A Harper,Simon %A Todd,Chris %+ School of Health Sciences, University of Manchester, Kilburn Building, LF1, Oxford Road, Manchester, M13 PL, United Kingdom, 44 161 275 6239, julia.mueller@manchester.ac.uk %K help seeking %K online health information %K health information seeking %K lung cancer %K symptom appraisal %D 2017 %7 08.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Delays to diagnosis in lung cancer can lead to reduced chance of survival, and patients often wait for several months before presenting symptoms. The time between first symptom recognition until diagnosis has been theorized into three intervals: symptom appraisal, help-seeking, and diagnostic interval (here: “pathway to diagnosis”). Interventions are needed to reduce delays to diagnosis in lung cancer. The Web has become an important lay health information source and could potentially play a role in this pathway to diagnosis. Objective: Our overall aim was to gain a preliminary insight into whether Web-based information plays a role in the pathway to diagnosis in lung cancer in order to assess whether it may be possible to leverage this information source to reduce delays to diagnosis. Methods: Patients diagnosed with lung cancer in the 6 months before study entry completed a survey about whether (and how, if yes) they had used the Web to appraise their condition prior to diagnosis. Based on survey responses, we purposively sampled patients and their next-of-kin for semistructured interviews (24 interviews; 33 participants). Interview data were analyzed qualitatively using Framework Analysis in the context of the pathway to diagnosis model. Results: A total of 113 patients completed the survey (age: mean 67.0, SD 8.8 years). In all, 20.4% (23/113) reported they or next-of-kin had researched their condition online before the diagnosis. The majority of searches (20/23, 87.0%) were conducted by or with the help of next-of-kin. Interview results suggest that patients and next-of-kin perceived an impact of the information found online on all three intervals in the time to diagnosis. In the appraisal interval, participants used online information to evaluate symptoms and possible causes. In the help-seeking interval, the Web was used to inform the decision of whether to present to health services. In the diagnostic interval, it was used to evaluate health care professionals’ advice, to support requests for further investigation of symptoms, and to understand medical jargon. Within this interval, we identified two distinct subintervals (before/after relevant diagnostic tests were initiated), in which the Web reportedly played different roles. Conclusions: Because only 20.4% of the sample reported prediagnosis Web searches, it seems the role of the Web before diagnosis of lung cancer is at present still limited, but this proportion is likely to increase in the future, when barriers such as unfamiliarity with technology and unwillingness to be informed about one’s own health are likely to decrease. Participants’ perceptions suggest that the Web can have an impact on all three intervals in the pathway to diagnosis. Thus, the Web may hold the potential to reduce delays in the diagnostic process, and this should be explored in future research and interventions. Our results also suggest a division of the diagnostic interval into two subintervals may be useful. %M 28596146 %R 10.2196/jmir.6336 %U http://www.jmir.org/2017/6/e189/ %U https://doi.org/10.2196/jmir.6336 %U http://www.ncbi.nlm.nih.gov/pubmed/28596146 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e194 %T “You Sort of Go Down a Rabbit Hole...You’re Just Going to Keep on Searching”: A Qualitative Study of Searching Online for Pregnancy-Related Information During Pregnancy %A Prescott,Julie %A Mackie,Lynn %+ Education and Psychology, University of Bolton, Deane Road, Bolton, BL3 5AB, United Kingdom, 44 0120490 ext 3676, j.prescott@bolton.ac.uk %K pregnancy %K information seeking behavior %K qualitative research %D 2017 %7 2.6.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The Web is becoming increasingly popular for gaining information on medical or health issues; with women in particular likely to search online for this type of information and support. Despite the increased use of the Web for health-related information, we need to question whether the Web and the ease of seeking health information that it provides leads to more (patient) empowerment. As well as being a time of joy and expectations, pregnancy can be a worrying time for women, especially first time mums-to-be, with unfamiliar experiences and symptoms and concerns for the baby as well as the self. Objective: Our aim was to explore how and why pregnant women use the Web to gain information and support during pregnancy and what they consider a reliable source. Methods: To meet the objectives of the study, a qualitative approach was required to gather information on the experiences of currently pregnant women who use the Web to gain information and support during their pregnancy. Sixteen pregnant women took part in a semistructured interview, either face-to-face or via telephone. The interviews took place from January to March 2016, all participants were from England, and the health professionals are all employed by the National Health Service (NHS). Qualitative analytical procedures were employed using inductive thematic analysis supported by NVivo software (QSR International). Results: Pregnant women found reassurance from the experiences of others. This reassurance resulted in them feeling less alone, as well as enabling them to normalize any symptoms or experiences they were undergoing. The women understood that caution was needed at times while reading the stories of others, acknowledging the potential for extreme cases or worst case scenarios. This is particularly pertinent to the Web, as this wide range of stories may not be as easily accessible if stories where confined to those in a woman’s offline social circle. The interviews provide insights into how and why pregnant women search online for information and perhaps more so, support while pregnant. Conclusions: Searching for health information and advice online during pregnancy is viewed as quick, easy, and accessible. The affordances of the Web have provided women the opportunity to go online as a first port of call. Knowing they were not alone and reading the experiences or symptoms of other pregnant women enabled women to normalize their experience and was ultimately reassuring for pregnant women. %M 28583906 %R 10.2196/jmir.6302 %U http://www.jmir.org/2017/19/e194/ %U https://doi.org/10.2196/jmir.6302 %U http://www.ncbi.nlm.nih.gov/pubmed/28583906 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 1 %P e6 %T Deconstructing Cancer Patient Information Seeking in a Consumer Health Library Toward Developing a Virtual Information Consult for Cancer Patients and Their Caregivers: A Qualitative, Instrumental Case Study %A Papadakos,Janet %A Trang,Aileen %A Cyr,Alaina B %A Abdelmutti,Nazek %A Giuliani,Meredith E %A Snow,Michelle %A McCurdie,Tara %A Pulandiran,Menaka %A Urowitz,Sara %A Wiljer,David %+ Cancer Education Program, Princess Margaret Cancer Centre, University Health Network, Princess Margaret Cancer Centre, ELLICSR B-PMB 130, 585 University Avenue, Toronto, ON, M5G 2C4, Canada, 1 416 5817679, janet.papadakos@uhn.ca %K patient education %K information-seeking behavior %K health literacy %K Internet %K consumer health information %D 2017 %7 24.05.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer patients and their caregivers want information about their disease and are interested in finding health information online. Despite the abundance of cancer information online, it is often fragmented, its quality is highly variable, and it can be difficult to navigate without expert-level knowledge of the cancer system. The Patient & Family Library at the Princess Margaret Cancer Centre offers a broad collection of high-quality cancer health information and staff are available to help patrons refine their questions and explore information needs that they may not have considered. Objective: The purpose of this research study was to deconstruct patrons’ information-seeking behaviors in the library to assess the feasibility of replicating the services provided in the library through a Web app, extending the service beyond the walls of the cancer centre. The specific aims of this research were to understand (1) how patrons approach information seeking in the library (interface design), (2) how patrons communicate their informational needs (information categorization and metadata requirements), and (3) what resources are provided to address the patrons’ information needs (collection development). Methods: We employed a qualitative, instrumental case study to deconstruct patrons’ health information-seeking behavior. The study population included patients, the librarian, and library volunteers. Ethnographic observation was conducted at the library over 3 days and key informant interviews with library staff were conducted to address the first aim. A closed card-sorting activity was conducted to address the second aim and the library shift logs and Search Request Forms (SRFs) were reviewed to address the third aim. Results: A total of 55 interactions were recorded during the ethnographic observation and nine semistructured interviews were conducted during the key informant interviews. Seven library patron personas were identified: (1) Newbie, (2) Seasoned, (3) Direct, (4) Window Shopper, (5) Collector, (6) Information Seeker, and (7) Distressed. A total of 83 participants completed the closed card-sorting exercise. The participants’ conceptual clusters within the similarity matrix overlapped with the groupings created by the librarian, with a few differences. A total of 161 entries in the library shift log and 65 SRFs were analyzed to determine what resources were given to patrons. Most resources that patrons received were available online (61%), although almost half of these required special access (47%). Conclusions: The study findings suggest it is possible to replicate library functions in a Web app with a few exceptions that cannot be replicated online. These elements include access to journal articles or other content behind paywalls and the librarian’s ability to encourage further discussion through empathy and active listening. Discussion with the librarian could serve to refine and predict needs through observing information seekers and to provide immediate connection to spiritual care and psychosocial support for patrons in distress. %M 28539305 %R 10.2196/cancer.6933 %U http://cancer.jmir.org/2017/1/e6/ %U https://doi.org/10.2196/cancer.6933 %U http://www.ncbi.nlm.nih.gov/pubmed/28539305 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e159 %T Identifying and Understanding the Health Information Experiences and Preferences of Caregivers of Individuals With Either Traumatic Brain Injury, Spinal Cord Injury, or Burn Injury: A Qualitative Investigation %A Coffey,Nathan T %A Cassese,James %A Cai,Xinsheng %A Garfinkel,Steven %A Patel,Drasti %A Jones,Rebecca %A Shaewitz,Dahlia %A Weinstein,Ali A %+ Center for the Study of Chronic Illness and Disability, George Mason University, 4400 University Drive, MSN 5B7, Fairfax, VA, 22030, United States, 1 703 993 9632, aweinst2@gmu.edu %K traumatic brain injury %K burns %K spinal cord injuries %K caregivers %K health information, consumer %K qualitative research %D 2017 %7 10.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: In order to meet the challenges of caring for an injured person, caregivers need access to health information. However, caregivers often feel that they lack adequate information. Previous studies of caregivers have primarily focused on either their time and emotional burdens or their health outcomes, but the information needs of caregivers have not been thoroughly investigated. Objective: The purpose of this investigation was to identify the preferred sources of health information for caregivers supporting individuals with injuries and to explore how access to this information could be improved. Methods: A total of 32 caregivers participated in semistructured interviews, which were used in order to develop a more in-depth understanding of these caregivers’ information needs. Digital audio recordings of the interviews were used for analysis purposes. These audio recordings were analyzed using a thematic analysis or qualitative content analysis. All of participant’s interviews were then coded using the qualitative analysis program, Nvivo 10 for Mac (QSR International). Results: The caregivers endorsed similar behaviors and preferences when seeking and accessing health information. Medical professionals were the preferred source of information, while ease of access made the Internet the most common avenue to obtain information. The challenges faced by participants were frequently a result of limited support. In describing an ideal health system, participants expressed interest in a comprehensive care website offering support network resources, instructive services about the injury and caregiving, and injury-specific materials. Conclusions: According to the participants, an ideal health information system would include a comprehensive care website that offered supportive network resources, instructive services about the injury and caregiving, and materials specific to the type of patient injury. %M 28490418 %R 10.2196/jmir.7027 %U http://www.jmir.org/2017/5/e159/ %U https://doi.org/10.2196/jmir.7027 %U http://www.ncbi.nlm.nih.gov/pubmed/28490418 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e13 %T Gathering Opinions on Depression Information Needs and Preferences: Samples and Opinions in Clinic Versus Web-Based Surveys %A Bernstein,Matthew T %A Walker,John R %A Sexton,Kathryn A %A Katz,Alan %A Beatie,Brooke E %A , %+ Faculty of Health Sciences, Department of Clinical Health Psychology, University of Manitoba, M4 - St. Boniface Hospital, 409 Tache Ave, Winnipeg, MB, R2H 2A6, Canada, 1 204 955 9487, jwalker@cc.umanitoba.ca %K depression %K psychotherapy %K drug therapy %K Internet %K survey methodology %D 2017 %7 24.04.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: There has been limited research on the information needs and preferences of the public concerning treatment for depression. Very little research is available comparing samples and opinions when recruitment for surveys is done over the Web as opposed to a personal invitation to complete a paper survey. Objective: This study aimed to (1) to explore information needs and preferences among members of the public and (2) compare Clinic and Web samples on sample characteristics and survey findings. Methods: Web survey participants were recruited with a notice on three self-help association websites (N=280). Clinic survey participants were recruited by a research assistant in the waiting rooms of a family medicine clinic and a walk-in medical clinic (N=238) and completed a paper version of the survey. Results: The Clinic and Web samples were similar in age (39.0 years, SD 13.9 vs 40.2 years, SD 12.5, respectively), education, and proportion in full time employment. The Clinic sample was more diverse in demographic characteristics and closer to the demographic characteristics of the region (Winnipeg, Canada) with a higher proportion of males (102/238 [42.9%] vs 45/280 [16.1%]) and nonwhites (Aboriginal, Asian, and black) (69/238 [29.0%] vs 39/280 [13.9%]). The Web sample reported a higher level of emotional distress and had more previous psychological (224/280 [80.0%] vs 83/238 [34.9%]) and pharmacological (202/280 [72.1%] vs 57/238 [23.9%]) treatment. In terms of opinions, most respondents in both settings saw information on a wide range of topics around depression treatment as very important including information about treatment choices, effectiveness of treatment, how long it takes treatment to work, how long treatment continues, what happens when treatment stops, advantages and disadvantages of treatments, and potential side effects. Females, respondents with a white background, and those who had received or felt they would have benefited from therapy in the past saw more information topics as very important. Those who had received or thought they would have benefited in the past from medication treatment saw fewer topics as important. Participants in both groups expressed an interest in receiving information through discussion with a counselor or a physician, through written brochures, or through a recommended website. Conclusions: The recruitment strategies were helpful in obtaining opinions from members of the public with different concerns and perspectives, and the results from the two methods were complementary. Persons coping with emotional distress and individuals not specifically seeking help for depression would be interested in information to answer a wide range of important questions about depression treatment. The Clinic sample yielded more cultural diversity that is a closer match to the population. The Web sample was less costly to recruit and included persons who were most interested in receiving information. %M 28438729 %R 10.2196/mental.7231 %U http://mental.jmir.org/2017/2/e13/ %U https://doi.org/10.2196/mental.7231 %U http://www.ncbi.nlm.nih.gov/pubmed/28438729 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e126 %T Seeking Web-Based Information About Attention Deficit Hyperactivity Disorder: Where, What, and When %A Rosenblum,Sara %A Yom-Tov,Elad %+ Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, University of Haifa, Eshkol Bldg, 9th Fl, Abba Khoushy Ave 199, Haifa, 3498838, Israel, 972 4 824 0474, rosens@research.haifa.ac.il %K attention deficit hyperactivity disorder %K Internet %K search engine %K coping behavior %K parents %D 2017 %7 21.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, prevalent among 2-10% of the population. Objective: The objective of this study was to describe where, what, and when people search online for topics related to ADHD. Methods: Data were collected from Microsoft’s Bing search engine and from the community question and answer site, Yahoo Answers. The questions were analyzed based on keywords and using further statistical methods. Results: Our results revealed that the Internet indeed constitutes a source of information for people searching the topic of ADHD, and that they search for information mostly about ADHD symptoms. Furthermore, individuals personally affected by the disorder made 2.0 more questions about ADHD compared with others. Questions begin when children reach 2 years of age, with an average age of 5.1 years. Most of the websites searched were not specifically related to ADHD and the timing of searches as well as the query content were different among those prediagnosis compared with postdiagnosis. Conclusions: The study results shed light on the features of ADHD-related searches. Thus, they may help improve the Internet as a source of reliable information, and promote improved awareness and knowledge about ADHD as well as quality of life for populations dealing with the complex phenomena of ADHD. %M 28432038 %R 10.2196/jmir.6579 %U http://www.jmir.org/2017/4/e126/ %U https://doi.org/10.2196/jmir.6579 %U http://www.ncbi.nlm.nih.gov/pubmed/28432038 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e117 %T eHealth Search Patterns: A Comparison of Private and Public Health Care Markets Using Online Panel Data %A Schneider,Janina Anne %A Holland,Christopher Patrick %+ Alliance Manchester Business School, University of Manchester, Booth Street East, Manchester, M13 9PL, United Kingdom, 44 161 820 8344 ext 56460, chris.holland@manchester.ac.uk %K health information management %K medical informatics %K information science %D 2017 %7 13.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient and consumer access to eHealth information is of crucial importance because of its role in patient-centered medicine and to improve knowledge about general aspects of health and medical topics. Objectives: The objectives were to analyze and compare eHealth search patterns in a private (United States) and a public (United Kingdom) health care market. Methods: A new taxonomy of eHealth websites is proposed to organize the largest eHealth websites. An online measurement framework is developed that provides a precise and detailed measurement system. Online panel data are used to accurately track and analyze detailed search behavior across 100 of the largest eHealth websites in the US and UK health care markets. Results: The health, medical, and lifestyle categories account for approximately 90% of online activity, and e-pharmacies, social media, and professional categories account for the remaining 10% of online activity. Overall search penetration of eHealth websites is significantly higher in the private (United States) than the public market (United Kingdom). Almost twice the number of eHealth users in the private market have adopted online search in the health and lifestyle categories and also spend more time per website than those in the public market. The use of medical websites for specific conditions is almost identical in both markets. The allocation of search effort across categories is similar in both the markets. For all categories, the vast majority of eHealth users only access one website within each category. Those that conduct a search of two or more websites display very narrow search patterns. All users spend relatively little time on eHealth, that is, 3-7 minutes per website. Conclusions: The proposed online measurement framework exploits online panel data to provide a powerful and objective method of analyzing and exploring eHealth behavior. The private health care system does appear to have an influence on eHealth search behavior in terms of search penetration and time spent per website in the health and lifestyle categories. Two explanations are offered: (1) the personal incentive of medical costs in the private market incentivizes users to conduct online search; and (2) health care information is more easily accessible through health care professionals in the United Kingdom compared with the United States. However, the use of medical websites is almost identical, suggesting that patients interested in a specific condition have a motivation to search and evaluate health information, irrespective of the health care market. The relatively low level of search in terms of the number of websites accessed and the average time per website raise important questions about the actual level of patient informedness in both the markets. Areas for future research are outlined. %M 28408362 %R 10.2196/jmir.6739 %U http://www.jmir.org/2017/4/e117/ %U https://doi.org/10.2196/jmir.6739 %U http://www.ncbi.nlm.nih.gov/pubmed/28408362 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e92 %T Gender-Specific Determinants and Patterns of Online Health Information Seeking: Results From a Representative German Health Survey %A Baumann,Eva %A Czerwinski,Fabian %A Reifegerste,Doreen %+ Hanover Center for Health Communication, Department of Journalism and Communication Research, Hanover University of Music, Drama, and Media, Expo Plaza 12, Hanover, 30539, Germany, 49 (05 11) 31 00 ext 448, doreen.reifegerste@ijk.hmtm-hannover.de %K health information seeking %K social media %K gender differences %K frequency of seeking %K Internet %D 2017 %7 04.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health information-seeking behavior (OHISB) is currently a widespread and common behavior that has been described as an important prerequisite of empowerment and health literacy. Although demographic factors such as socioeconomic status (SES), age, and gender have been identified as important determinants of OHISB, research is limited regarding the gender-specific motivational determinants of OHISB and differences between women and men in the use of online resources for health information purposes. Objective: The aim of this study was to identify gender-specific determinants and patterns of OHISB by analyzing data from a representative German sample of adults (N=1728) with special attention to access and frequency of use as well as topics and sources of OHISB. Methods: We employed a 2-step analysis, that is, after exploring differences between users and nonusers of online health information using logistic regression models, we highlighted gender-specific determinants of the frequency of OHISB by applying zero-truncated negative binomial models. Results: Age (odds ratio, OR for females=0.97, 95% CI 0.96-0.99) and degree of satisfaction with one’s general practitioner (GP) (OR for males=0.73, 95% CI 0.57-0.92) were gender-specific determinants of access to OHISB. Regarding the frequency of OHISB, daily Internet use (incidence rate ratio, IRR=1.67, 95% CI 1.19-2.33) and a strong interest in health topics (IRR=1.45, 95% CI 1.19-1.77) were revealed to be more important predictors than SES (IRR for high SES=1.25, 95% CI 0.91-1.73). Conclusions: Users indicate that the Internet seems to be capable of providing a valuable source of informational support and patient empowerment. Increasing the potential value of the Internet as a source for health literacy and patient empowerment requires need-oriented and gender-specific health communication efforts, media, and information strategies. %M 28377367 %R 10.2196/jmir.6668 %U http://www.jmir.org/2017/4/e92/ %U https://doi.org/10.2196/jmir.6668 %U http://www.ncbi.nlm.nih.gov/pubmed/28377367 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 2 %P e51 %T Internet Use by Parents of Children With Rare Conditions: Findings From a Study on Parents’ Web Information Needs %A Nicholl,Honor %A Tracey,Catherine %A Begley,Thelma %A King,Carole %A Lynch,Aileen M %+ School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin, 24 D'Olier Street, Dublin, D2, Ireland, 353 18968571, amlynch@tcd.ie %K rare diseases %K parents %K Internet %K consumer health information %K social media %K professional-patient relations %D 2017 %7 28.02.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Parents of children with rare conditions increasingly use the Internet to source information on their child’s condition. This study reports on part of a larger study whose overall aim was to identify the Internet use by parents when seeking information on their child’s rare condition, with the specific purpose of using the findings to aid in the development of a website specifically designed to meet the parents’ needs. It presents findings on why these parents use the Internet, the information and support content they source, and the impact these resources have on their capacity to care for and manage their child’s condition. Objective: To (1) ascertain parents’ general Internet usage patterns, (2) identify the nature of the information parents most frequently searched for, and (3) determine the effect the Internet-sourced information had on parents of children with rare conditions. Methods: Data collection was conducted in 2 parts: Part 1 was a focus group interview (n=8) to inform the development of the questionnaire, and Part 2 was a questionnaire (Web- and paper-based). All respondents (N=128) completed the questionnaire using the Internet. Results: Parents frequently and habitually used the Internet and social media to gather information on their child’s condition. These Web-based resources provide parents with a parent-to-parent support platform that allows them to share their experiences and information with other parents, which, the respondents considered, improved their knowledge and understanding of their child’s condition. The respondents also reported that these resources positively impacted on their decision making, care, and management of their child’s condition. However, they reported receiving mixed responses when wishing to engage and share with health care professionals their Internet and social media interactions and information outcomes. Conclusions: This study adds to the emerging body of research on the Internet use by parents of children with rare conditions to source information on their child’s condition. The evolving and ever increasing parent-to-parent support systems via social media are impacting on parents’ capacity to manage their children. Implications for practice include health care professionals’ response to this knowledge and capacity shift, and the significance of these changes when interacting with parents. The key message of this study was that parents of children with rare conditions are habitual users of the Internet to source information about their children’s conditions. Social media, especially Facebook, has an increasing role in the lives of these parents for information and support. Parents’ interest in information gathering and sharing includes a desire for shared dialogue with health care professionals. %M 28246072 %R 10.2196/jmir.5834 %U http://www.jmir.org/2017/2/e51/ %U https://doi.org/10.2196/jmir.5834 %U http://www.ncbi.nlm.nih.gov/pubmed/28246072 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 1 %P e4 %T Ontology-Driven Search and Triage: Design of a Web-Based Visual Interface for MEDLINE %A Demelo,Jonathan %A Parsons,Paul %A Sedig,Kamran %+ Purdue Polytechnic Institute, Department of Computer Graphics Technology, Purdue University, Knoy Hall, 401 N Grant St, West Lafayette, IN, 47907, United States, 1 765 494 0511, parsonsp@purdue.edu %K MEDLINE %K user-computer interface %K information storage and retrieval %K medical informatics %K PubMed %D 2017 %7 02.02.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Diverse users need to search health and medical literature to satisfy open-ended goals such as making evidence-based decisions and updating their knowledge. However, doing so is challenging due to at least two major difficulties: (1) articulating information needs using accurate vocabulary and (2) dealing with large document sets returned from searches. Common search interfaces such as PubMed do not provide adequate support for exploratory search tasks. Objective: Our objective was to improve support for exploratory search tasks by combining two strategies in the design of an interactive visual interface by (1) using a formal ontology to help users build domain-specific knowledge and vocabulary and (2) providing multi-stage triaging support to help mitigate the information overload problem. Methods: We developed a Web-based tool, Ontology-Driven Visual Search and Triage Interface for MEDLINE (OVERT-MED), to test our design ideas. We implemented a custom searchable index of MEDLINE, which comprises approximately 25 million document citations. We chose a popular biomedical ontology, the Human Phenotype Ontology (HPO), to test our solution to the vocabulary problem. We implemented multistage triaging support in OVERT-MED, with the aid of interactive visualization techniques, to help users deal with large document sets returned from searches. Results: Formative evaluation suggests that the design features in OVERT-MED are helpful in addressing the two major difficulties described above. Using a formal ontology seems to help users articulate their information needs with more accurate vocabulary. In addition, multistage triaging combined with interactive visualizations shows promise in mitigating the information overload problem. Conclusions: Our strategies appear to be valuable in addressing the two major problems in exploratory search. Although we tested OVERT-MED with a particular ontology and document collection, we anticipate that our strategies can be transferred successfully to other contexts. %M 28153818 %R 10.2196/medinform.6918 %U http://medinform.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/medinform.6918 %U http://www.ncbi.nlm.nih.gov/pubmed/28153818 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e9 %T Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review %A Tan,Sharon Swee-Lin %A Goonawardene,Nadee %+ Center for Health Informatics, Department of Information Systems, National University of Singapore, Computing 1, 13 Computing Drive, Singapore, 117417, Singapore, 65 65164866, tansl@comp.nus.edu.sg %K Internet %K information seeking %K physician-patient relations %K health information %D 2017 %7 19.01.2017 %9 Review %J J Med Internet Res %G English %X Background: With online health information becoming increasingly popular among patients, concerns have been raised about the impact of patients’ Internet health information-seeking behavior on their relationship with physicians. Therefore, it is pertinent to understand the influence of online health information on the patient-physician relationship. Objective: Our objective was to systematically review existing research on patients’ Internet health information seeking and its influence on the patient-physician relationship. Methods: We systematically searched PubMed and key medical informatics, information systems, and communication science journals covering the period of 2000 to 2015. Empirical articles that were in English were included. We analyzed the content covering themes in 2 broad categories: factors affecting patients’ discussion of online findings during consultations and implications for the patient-physician relationship. Results: We identified 18 articles that met the inclusion criteria and the quality requirement for the review. The articles revealed barriers, facilitators, and demographic factors that influence patients’ disclosure of online health information during consultations and the different mechanisms patients use to reveal these findings. Our review also showed the mechanisms in which online information could influence patients’ relationship with their physicians. Conclusions: Results of this review contribute to the understanding of the patient-physician relationship of Internet-informed patients. Our main findings show that Internet health information seeking can improve the patient-physician relationship depending on whether the patient discusses the information with the physician and on their prior relationship. As patients have better access to health information through the Internet and expect to be more engaged in health decision making, traditional models of the patient-provider relationship and communication strategies must be revisited to adapt to this changing demographic. %M 28104579 %R 10.2196/jmir.5729 %U http://www.jmir.org/2017/1/e9/ %U https://doi.org/10.2196/jmir.5729 %U http://www.ncbi.nlm.nih.gov/pubmed/28104579 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e269 %T The Relationship Between Health Management and Information Behavior Over Time: A Study of the Illness Journeys of People Living With Fibromyalgia %A Chen,Annie T %+ University of Washington School of Medicine, Department of Biomedical Informatics and Medical Education, 850 Republican St., Box 358047, C238, Seattle, WA, 98109, United States, 1 206 221 9218, atchen@uw.edu %K health knowledge, attitudes, practice %K information seeking behavior %K information use %K consumer health information %K chronic disease %K fibromyalgia %D 2016 %7 25.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Over the course of a chronic illness, patients face many challenges, including understanding what is happening to them and developing an effective strategy for managing illness. While there is existing literature concerning how people seek health-related information and cope with chronic illnesses, there is a need for additional research on how information affects patients’ understandings of their illness, and how changes in this understanding affect their health management strategies over time. Objective: This study examined how health management, information seeking, and information consumption and use processes are related throughout an illness. Methods: A diversified recruitment strategy involving multiple media channels was used to recruit participants for an interview study. During the interviews, participants were asked to draw an “illness journey” timeline. The data were analyzed using a qualitative approach drawn from Interpretative Phenomenological Analysis and Grounded Theory. Results: The study identified four main health management features of illness journeys: onset, progression toward diagnosis, acceptance, and development of an effective management strategy. The study then focused on how information seeking changes over illness journeys, particularly in terms of a transition from active information seeking to monitoring with intermittent focused searching. Last, the paper describes the information consumption and use processes that patients engaged in throughout their journey. Conclusions: This study makes three important contributions to the field. First, it presents an integrated conceptualization of how health management and information behaviors are related on illness journeys. Second, it adds to our existing knowledge on health literacy and self-management of chronic illness. Third, the study has implications for health interface design. %M 27780794 %R 10.2196/jmir.5309 %U http://www.jmir.org/2016/10/e269/ %U https://doi.org/10.2196/jmir.5309 %U http://www.ncbi.nlm.nih.gov/pubmed/27780794 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e123 %T Health Information Brokers in the General Population: An Analysis of the Health Information National Trends Survey 2013-2014 %A Cutrona,Sarah L %A Mazor,Kathleen M %A Agunwamba,Amenah A %A Valluri,Sruthi %A Wilson,Patrick M %A Sadasivam,Rajani S %A Finney Rutten,Lila J %+ University of Massachusetts Medical School, Department of Medicine, 365 Plantation St, Biotech 1 Suite 100, Worcester, MA, 01605, United States, 1 508 856 3086, Sarah.Cutrona@umassmemorial.org %K health information seeking %K peer communication %K social network %K patient self-management %K health care decision-making %D 2016 %7 03.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Health information exchanged between friends or family members can influence decision making, both for routine health questions and for serious health issues. A health information broker is a person to whom friends and family turn for advice or information on health-related topics. Characteristics and online behaviors of health information brokers have not previously been studied in a national population. Objective: The objective of this study was to examine sociodemographic characteristics, health information seeking behaviors, and other online behaviors among health information brokers. Methods: Data from the Health Information National Trends Survey (2013-2014; n=3142) were used to compare brokers with nonbrokers. Modified Poisson regression was used to examine the relationship between broker status and sociodemographics and online information seeking. Results: Over half (54.8%) of the respondents were consulted by family or friends for advice or information on health topics (ie, they acted as health information brokers). Brokers represented 54.1% of respondents earning <$20,000 yearly and 56.5% of respondents born outside the United States. Women were more likely to be brokers (PR 1.34, 95% CI 1.23-1.47) as were those with education past high school (PR 1.42, CI 1.22-1.65). People aged ≥75 were less likely to be brokers as compared to respondents aged 35-49 (PR 0.81, CI 0.67-0.99). Brokers used the Internet more frequently for a variety of online behaviors such as seeking health information, creating and sharing online content, and downloading health information onto a mobile device; and also reported greater confidence in obtaining health information online. Conclusions: More than 50% of adults who responded to this national survey, including those with low income and those born abroad, were providing health information or advice to friends and family. These individuals may prove to be effective targets for initiatives supporting patient engagement and disease management, and may also be well-positioned within their respective social networks to propagate health messages. %M 27260952 %R 10.2196/jmir.5447 %U http://www.jmir.org/2016/6/e123/ %U https://doi.org/10.2196/jmir.5447 %U http://www.ncbi.nlm.nih.gov/pubmed/27260952 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e137 %T Manipulating Google’s Knowledge Graph Box to Counter Biased Information Processing During an Online Search on Vaccination: Application of a Technological Debiasing Strategy %A Ludolph,Ramona %A Allam,Ahmed %A Schulz,Peter J %+ Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano (Università della Svizzera italiana), Via G. Buffi 13, Lugano, 6904, Switzerland, 41 58666 ext 4821, ramona.alexandra.ludolph@usi.ch %K search engine %K online health information search %K vaccination %K debiasing %K search behavior %K health communication %K information processing %K information seeking %D 2016 %7 02.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: One of people’s major motives for going online is the search for health-related information. Most consumers start their search with a general search engine but are unaware of the fact that its sorting and ranking criteria do not mirror information quality. This misconception can lead to distorted search outcomes, especially when the information processing is characterized by heuristic principles and resulting cognitive biases instead of a systematic elaboration. As vaccination opponents are vocal on the Web, the chance of encountering their non‒evidence-based views on immunization is high. Therefore, biased information processing in this context can cause subsequent impaired judgment and decision making. A technological debiasing strategy could counter this by changing people’s search environment. Objective: This study aims at testing a technological debiasing strategy to reduce the negative effects of biased information processing when using a general search engine on people’s vaccination-related knowledge and attitudes. This strategy is to manipulate the content of Google’s knowledge graph box, which is integrated in the search interface and provides basic information about the search topic. Methods: A full 3x2 factorial, posttest-only design was employed with availability of basic factual information (comprehensible vs hardly comprehensible vs not present) as the first factor and a warning message as the second factor of experimental manipulation. Outcome variables were the evaluation of the knowledge graph box, vaccination-related knowledge, as well as beliefs and attitudes toward vaccination, as represented by three latent variables emerged from an exploratory factor analysis. Results: Two-way analysis of variance revealed a significant main effect of availability of basic information in the knowledge graph box on participants’ vaccination knowledge scores (F2,273=4.86, P=.01), skepticism/fear of vaccination side effects (F2,273=3.5, P=.03), and perceived information quality (F2,273=3.73, P=.02). More specifically, respondents receiving comprehensible information appeared to be more knowledgeable, less skeptical of vaccination, and more critical of information quality compared to participants exposed to hardly comprehensible information. Although, there was no significant interaction effect between the availability of information and the presence of the warning, there was a dominant pattern in which the presence of the warning appeared to have a positive influence on the group receiving comprehensible information while the opposite was true for the groups exposed to hardly comprehensible information and no information at all. Participants evaluated the knowledge graph box as moderately to highly useful, with no significant differences among the experimental groups. Conclusion: Overall, the results suggest that comprehensible information in the knowledge graph box positively affects participants’ vaccination-related knowledge and attitudes. A small change in the content retrieval procedure currently used by Google could already make a valuable difference in the pursuit of an unbiased online information search. Further research is needed to gain insights into the knowledge graph box’s entire potential. %M 27255736 %R 10.2196/jmir.5430 %U http://www.jmir.org/2016/6/e137/ %U https://doi.org/10.2196/jmir.5430 %U http://www.ncbi.nlm.nih.gov/pubmed/27255736 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 4 %N 2 %P e12 %T A Querying Method over RDF-ized Health Level Seven v2.5 Messages Using Life Science Knowledge Resources %A Kawazoe,Yoshimasa %A Imai,Takeshi %A Ohe,Kazuhiko %+ Department of Healthcare Information Management, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 5800 8685, kawazoe@hcc.h.u-tokyo.ac.jp %K electronic health records %K health level seven %K information storage and retrieval %K Semantic Web %K linked open data %D 2016 %7 05.04.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Health level seven version 2.5 (HL7 v2.5) is a widespread messaging standard for information exchange between clinical information systems. By applying Semantic Web technologies for handling HL7 v2.5 messages, it is possible to integrate large-scale clinical data with life science knowledge resources. Objective: Showing feasibility of a querying method over large-scale resource description framework (RDF)-ized HL7 v2.5 messages using publicly available drug databases. Methods: We developed a method to convert HL7 v2.5 messages into the RDF. We also converted five kinds of drug databases into RDF and provided explicit links between the corresponding items among them. With those linked drug data, we then developed a method for query expansion to search the clinical data using semantic information on drug classes along with four types of temporal patterns. For evaluation purpose, medication orders and laboratory test results for a 3-year period at the University of Tokyo Hospital were used, and the query execution times were measured. Results: Approximately 650 million RDF triples for medication orders and 790 million RDF triples for laboratory test results were converted. Taking three types of query in use cases for detecting adverse events of drugs as an example, we confirmed these queries were represented in SPARQL Protocol and RDF Query Language (SPARQL) using our methods and comparison with conventional query expressions were performed. The measurement results confirm that the query time is feasible and increases logarithmically or linearly with the amount of data and without diverging. Conclusions: The proposed methods enabled query expressions that separate knowledge resources and clinical data, thereby suggesting the feasibility for improving the usability of clinical data by enhancing the knowledge resources. We also demonstrate that when HL7 v2.5 messages are automatically converted into RDF, searches are still possible through SPARQL without modifying the structure. As such, the proposed method benefits not only our hospitals, but also numerous hospitals that handle HL7 v2.5 messages. Our approach highlights a potential of large-scale data federation techniques to retrieve clinical information, which could be applied as applications of clinical intelligence to improve clinical practices, such as adverse drug event monitoring and cohort selection for a clinical study as well as discovering new knowledge from clinical information. %M 27050304 %R 10.2196/medinform.5275 %U http://medinform.jmir.org/2016/2/e12/ %U https://doi.org/10.2196/medinform.5275 %U http://www.ncbi.nlm.nih.gov/pubmed/27050304 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e64 %T Does Digital Ad Exposure Influence Information-Seeking Behavior Online? Evidence From the 2012 Tips From Former Smokers National Tobacco Prevention Campaign %A Kim,Annice %A Hansen,Heather %A Duke,Jennifer %A Davis,Kevin %A Alexander,Robert %A Rowland,Amy %A Mitchko,Jane %+ RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, , United States, 1 919 316 3972, akim@rti.org %K tobacco cessation %K health %K Internet %K monitoring and evaluation %D 2016 %7 16.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Measuring the impact of online health campaigns is challenging. Ad click-through rates are traditionally used to measure campaign reach, but few Internet users ever click on ads. Alternatively, self-reported exposure to digital ads would be prone to recall bias. Furthermore, there may be latency effects whereby people do not click on ads when exposed but visit the promoted website or conduct campaign-related searches later. Online panels that unobtrusively collect panelists’ Web behavior data and link ad exposure to website visits and searches can more reliably assess the impact of digital ad exposure. From March to June 2012, the Centers for Disease Control and Prevention aired the national Tips From Former Smokers (Tips 2012) media campaign designed to encourage current smokers to quit. Advertisements ran across media channels, and the digital ads directed users to the Tips 2012 campaign website. Objective: Our aim was to examine whether exposure to Tips 2012 digital ads influenced information-seeking behaviors online. Methods: ComScore mined its panelists’ Web behavior data for unique codes that would indicate exposure to Tips 2012 ads, regardless of whether panelists clicked the ad or not. A total of 15,319 US adults were identified as having been exposed to a Tips 2012 campaign ad. An equal number of unexposed adults (N=15,319) were identified and matched on demographics and Internet use behavior to the exposed group. Panelists’ Web behavior data were mined for up to 4 weeks after initial Tips 2012 ad exposure to determine whether they visited the Tips 2012 campaign website or other cessation-related websites (eg, nicotine replacement therapy site) or conducted searches for campaign-related topics (eg, quit smoking). Results: The proportion of exposed adults visiting the Tips 2012 sites increased from 0.4% in Week 1 to 0.9% 4 weeks after ad exposure, and these rates were significantly higher than in the unexposed group (0.1% in Week 1 to 0.4% in Week 4, P<.001) across all weeks examined. The proportion of exposed panelists visiting other cessation websites increased from 0.2% in Week 1 to 0.3% 4 weeks after initial ad exposure, and these rates were significantly higher than in the unexposed group (0.0% in Week 1 to 0.2% in Week 4, P=.001 to P=.019) across all weeks examined. There were no significant differences in searches for campaign-related topics between the exposed and unexposed group during most of the weeks examined. Conclusions: These results suggest that online ad exposure is associated with confirmed visits to the Tips 2012 campaign sites and visits to other cessation websites and that these information-seeking behaviors occur up to several weeks after ad exposure. Web behavior data from online panels are useful for examining exposure and behavioral responses to digital campaign ads. %M 26983849 %R 10.2196/jmir.4299 %U http://www.jmir.org/2016/3/e64/ %U https://doi.org/10.2196/jmir.4299 %U http://www.ncbi.nlm.nih.gov/pubmed/26983849 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 2 %N 1 %P e2 %T Predictors of Online Cancer Prevention Information Seeking Among Patients and Caregivers Across the Digital Divide: A Cross-Sectional, Correlational Study %A Ginossar,Tamar %+ University of New Mexico Cancer Center, Department of Communication and Journalism, University of New Mexico, Albuquerque, NM, , United States, 1 505 884 9251, ginossar@unm.edu %K digital divide %K Internet, information seeking behavior %K minority health %D 2016 %7 09.03.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: The digital divide is a recognized public health problem caused by social determinants that exacerbate health disparities. Despite the “tectonic shift” in how most of the public obtains cancer information, underserved communities are at increased risk of being digitally marginalized. However, research that examines factors underlying eHealth information seeking in diverse health contexts is lacking. Objective: The aim of this paper is to explore preferences and use of eHealth cancer prevention information (CPI) among patients and caregivers attending a minority-serving oncology clinic using the comprehensive model of information seeking as a theoretical framework. Specifically, the study examined the role of social determinants and prevention orientation in differences in preference and use of the Internet for CPI seeking among this diverse sample. Methods: Survey methodology was used to identify social determinants and behavioral factors, including prevention orientation as correlates and predictors of respondents’ (n=252) preferences and use of eHealth for CPI seeking. Results: Less than half (112/252, 44.4%) of respondents said that if faced with the need to seek CPI, they would seek this information online. In the final logistic regression model, education, ethnicity, age, and prevention orientation made significant contributions to the model (P<.05). Specifically, for each year increase in age, participants were 3% less likely to use the Internet for CPI seeking (P=.011). Compared to college graduates, respondents who did not complete high school were 11.75 times less likely to cite the Internet as a CPI carrier (P<.001) and those with a high school education were 3 times (2.99, P=.015) less likely. In addition, the odds that a Spanish speaker would cite the Internet as a CPI carrier were one-fifth (22%) of non-Hispanic whites (P=.032) and about one-quarter (26%) of English-speaking Latinos (P=.036). Finally, with each one point increase on the prevention orientation scale, respondents were 1.83 times less likely to cite online CPI seeking (P=.05). Conclusions: Social determinants to health have profound influence on eHealth CPI seeking. Providers and policy makers should focus on meeting patients and family members’ CPI needs following diagnosis and increase eHealth accessibility and availability of evidence-based CPI to diverse populations. Future research is needed to unravel further differences in eHealth CPI seeking, including those among Native Americans that emerged as an additional digitally underserved racial/ethnic group. Finally, additional factors underlying these differences should be explored to better tailor CPI eHealth information to diverse communities’ information needs. %M 28410177 %R 10.2196/cancer.5108 %U http://cancer.jmir.org/2016/1/e2/ %U https://doi.org/10.2196/cancer.5108 %U http://www.ncbi.nlm.nih.gov/pubmed/28410177 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e44 %T Finding the Patient’s Voice Using Big Data: Analysis of Users’ Health-Related Concerns in the ChaCha Question-and-Answer Service (2009–2012) %A Priest,Chad %A Knopf,Amelia %A Groves,Doyle %A Carpenter,Janet S %A Furrey,Christopher %A Krishnan,Anand %A Miller,Wendy R %A Otte,Julie L %A Palakal,Mathew %A Wiehe,Sarah %A Wilson,Jeffrey %+ Social Network Health Research Laboratory at the Indiana University School of Nursing, School of Medicine, Department of Emergency Medicine, Indiana University, Suite 3100, 410 W 10th St, Indianapolis, IN, 46202, United States, 1 317 278 4048, cspriest@iu.edu %K social meda %K health information seeking %K adolescent %K sexual health %K patient engagement %K ChaCha %K big data %K question-and-answer service %K infodemiology %K infoveillance %D 2016 %7 09.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The development of effective health care and public health interventions requires a comprehensive understanding of the perceptions, concerns, and stated needs of health care consumers and the public at large. Big datasets from social media and question-and-answer services provide insight into the public’s health concerns and priorities without the financial, temporal, and spatial encumbrances of more traditional community-engagement methods and may prove a useful starting point for public-engagement health research (infodemiology). Objective: The objective of our study was to describe user characteristics and health-related queries of the ChaCha question-and-answer platform, and discuss how these data may be used to better understand the perceptions, concerns, and stated needs of health care consumers and the public at large. Methods: We conducted a retrospective automated textual analysis of anonymous user-generated queries submitted to ChaCha between January 2009 and November 2012. A total of 2.004 billion queries were read, of which 3.50% (70,083,796/2,004,243,249) were missing 1 or more data fields, leaving 1.934 billion complete lines of data for these analyses. Results: Males and females submitted roughly equal numbers of health queries, but content differed by sex. Questions from females predominantly focused on pregnancy, menstruation, and vaginal health. Questions from males predominantly focused on body image, drug use, and sexuality. Adolescents aged 12–19 years submitted more queries than any other age group. Their queries were largely centered on sexual and reproductive health, and pregnancy in particular. Conclusions: The private nature of the ChaCha service provided a perfect environment for maximum frankness among users, especially among adolescents posing sensitive health questions. Adolescents’ sexual health queries reveal knowledge gaps with serious, lifelong consequences. The nature of questions to the service provides opportunities for rapid understanding of health concerns and may lead to development of more effective tailored interventions. %M 26960745 %R 10.2196/jmir.5033 %U http://www.jmir.org/2016/3/e44/ %U https://doi.org/10.2196/jmir.5033 %U http://www.ncbi.nlm.nih.gov/pubmed/26960745 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e14 %T Use of the Internet for Sexual Health Among Sexually Experienced Persons Aged 16 to 44 Years: Evidence from a Nationally Representative Survey of the British Population %A Aicken,Catherine RH %A Estcourt,Claudia S %A Johnson,Anne M %A Sonnenberg,Pam %A Wellings,Kaye %A Mercer,Catherine H %+ Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, Centre for Sexual Health and HIV Research, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, United Kingdom, 44 (0)20 3108 2067, c.aicken@ucl.ac.uk %K sexual health %K sexually transmitted diseases %K contraception %K health care-seeking behavior %K Internet %K eHealth %K surveys %K information-seeking behavior %D 2016 %7 20.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Those who go online regarding their sexual health are potential users of new Internet-based sexual health interventions. Understanding the size and characteristics of this population is important in informing intervention design and delivery. Objective: We aimed to estimate the prevalence in Britain of recent use of the Internet for key sexual health reasons (for chlamydia testing, human immunodeficiency virus [HIV] testing, sexually transmitted infection [STI] treatment, condoms/contraceptives, and help/advice with one’s sex life) and to identify associated sociodemographic and behavioral factors. Methods: Complex survey analysis of data from 8926 sexually experienced persons aged 16-44 years in a 2010-2012 probability survey of Britain’s resident population. Prevalence of recent (past year) use of Internet sources for key sexual health reasons was estimated. Factors associated with use of information/support websites were identified using logistic regression to calculate age-adjusted odds ratios (AORs). Results: Recent Internet use for chlamydia/HIV testing or STI treatment (combined) was very low (men: 0.31%; women: 0.16%), whereas 2.35% of men and 0.51% of women reported obtaining condoms/contraceptives online. Additionally, 4.49% of men and 4.57% of women reported recent use of information/support websites for advice/help with their sex lives. Prevalence declined with age (men 16-24 years: 7.7%; 35-44 years: 1.84%, P<.001; women 16-24 years: 7.8%; 35-44 years: 1.84%, P<.001). Use of information/support websites was strongly associated with men’s higher socioeconomic status (managerial/professional vs semiroutine/routine: AOR 1.93, 95% CI 1.27-2.93, P<.001). Despite no overall association with area-level deprivation, those in densely populated urban areas were more likely to report use of information/support websites than those living in rural areas (men: AOR 3.38, 95% CI 1.68-6.77, P<.001; women: AOR 2.51, 95% CI 1.34-4.70, P<.001). No statistically significant association was observed with number of sex partners reported after age adjustment, but use was more common among men reporting same-sex partners (last 5 years: AOR 2.44, 95% CI 1.27-4.70), women reporting sex with multiple partners without condoms (last year: AOR 1.90, 95% CI 1.11-3.26), and, among both sexes, reporting seeking sex online (last year, men: AOR 1.80, 95% CI 1.16-2.79; women: AOR 3.00, 95% CI 1.76-5.13). No association was observed with reporting STI diagnosis/es (last 5 years) or (after age adjustment) recent use of any STI service or non-Internet sexual health seeking. Conclusions: A minority in Britain used the Internet for the sexual health reasons examined. Use of information/support websites was reported by those at greater STI risk, including younger people, indicating that demand for online STI services, and Internet-based sexual health interventions in general, may increase over time in this and subsequent cohorts. However, the impact on health inequalities needs addressing during design and evaluation of online sexual health interventions so that they maximize public health benefit. %M 26792090 %R 10.2196/jmir.4373 %U http://www.jmir.org/2016/1/e14/ %U https://doi.org/10.2196/jmir.4373 %U http://www.ncbi.nlm.nih.gov/pubmed/26792090 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e288 %T Consumer Use of “Dr Google”: A Survey on Health Information-Seeking Behaviors and Navigational Needs %A Lee,Kenneth %A Hoti,Kreshnik %A Hughes,Jeffery David %A Emmerton,Lynne M %+ Curtin University, School of Pharmacy, Curtin University, GPO Box U1987, Perth, 6845, Australia, 61 892667352, lynne.emmerton@curtin.edu.au %K online %K health information %K health literacy %K patient activation %K information seeking %K information needs %K Internet %K chronic disease %K patients %K survey %D 2015 %7 29.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet provides a platform to access health information and support self-management by consumers with chronic health conditions. Despite recognized barriers to accessing Web-based health information, there is a lack of research quantitatively exploring whether consumers report difficulty finding desired health information on the Internet and whether these consumers would like assistance (ie, navigational needs). Understanding navigational needs can provide a basis for interventions guiding consumers to quality Web-based health resources. Objective: We aimed to (1) estimate the proportion of consumers with navigational needs among seekers of Web-based health information with chronic health conditions, (2) describe Web-based health information-seeking behaviors, level of patient activation, and level of eHealth literacy among consumers with navigational needs, and (3) explore variables predicting navigational needs. Methods: A questionnaire was developed based on findings from a qualitative study on Web-based health information-seeking behaviors and navigational needs. This questionnaire also incorporated the eHealth Literacy Scale (eHEALS; a measure of self-perceived eHealth literacy) and PAM-13 (a measure of patient activation). The target population was consumers of Web-based health information with chronic health conditions. We surveyed a sample of 400 Australian adults, with recruitment coordinated by Qualtrics. This sample size was required to estimate the proportion of consumers identified with navigational needs with a precision of 4.9% either side of the true population value, with 95% confidence. A subsample was invited to retake the survey after 2 weeks to assess the test-retest reliability of the eHEALS and PAM-13. Results: Of 514 individuals who met our eligibility criteria, 400 (77.8%) completed the questionnaire and 43 participants completed the retest. Approximately half (51.3%; 95% CI 46.4-56.2) of the population was identified with navigational needs. Participants with navigational needs appeared to look for more types of health information on the Internet and from a greater variety of information sources compared to participants without navigational needs. However, participants with navigational needs were significantly less likely to have high levels of eHealth literacy (adjusted odds ratio=0.83, 95% CI 0.78-0.89, P<.001). Age was also a significant predictor (P=.02). Conclusions: Approximately half of the population of consumers of Web-based health information with chronic health conditions would benefit from support in finding health information on the Internet. Despite the popularity of the Internet as a source of health information, further work is recommended to maximize its potential as a tool to assist self-management in consumers with chronic health conditions. %M 26715363 %R 10.2196/jmir.4345 %U http://www.jmir.org/2015/12/e288/ %U https://doi.org/10.2196/jmir.4345 %U http://www.ncbi.nlm.nih.gov/pubmed/26715363 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e261 %T The Association Between Online Health Information–Seeking Behaviors and Health Behaviors Among Hispanics in New York City: A Community-Based Cross-Sectional Study %A Lee,Young Ji %A Boden-Albala,Bernadette %A Jia,Haomiao %A Wilcox,Adam %A Bakken,Suzanne %+ Department of Health and Community Systems, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15261, United States, 1 412 624 7886, leeyoung@pitt.edu %K Internet %K information-seeking behavior %K health behavior %K consumer health information %K Hispanic Americans %D 2015 %7 26.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Hispanics are the fastest-growing minority group in the United States and they suffer from a disproportionate burden of chronic diseases. Studies have shown that online health information has the potential to affect health behaviors and influence management of chronic disease for a significant proportion of the population, but little research has focused on Hispanics. Objective: The specific aim of this descriptive, cross-sectional study was to examine the association between online health information–seeking behaviors and health behaviors (physical activity, fruit and vegetable consumption, alcohol use, and hypertension medication adherence) among Hispanics. Methods: Data were collected from a convenience sample (N=2680) of Hispanics living in northern Manhattan by bilingual community health workers in a face-to-face interview and analyzed using linear and ordinal logistic regression. Variable selection and statistical analyses were guided by the Integrative Model of eHealth Use. Results: Only 7.38% (198/2680) of the sample reported online health information–seeking behaviors. Levels of moderate physical activity and fruit, vegetable, and alcohol consumption were low. Among individuals taking hypertension medication (n=825), adherence was reported as high by approximately one-third (30.9%, 255/825) of the sample. Controlling for demographic, situational, and literacy variables, online health information–seeking behaviors were significantly associated with fruit (β=0.35, 95% CI 0.08-0.62, P=.01) and vegetable (β=0.36, 95% CI 0.06-0.65, P=.02) consumption and physical activity (β=3.73, 95% CI 1.99-5.46, P<.001), but not alcohol consumption or hypertension medication adherence. In the regression models, literacy factors, which were used as control variables, were associated with 3 health behaviors: social networking site membership (used to measure one dimension of computer literacy) was associated with fruit consumption (β=0.23, 95% CI 0.05-0.42, P=.02), health literacy was associated with alcohol consumption (β=0.44, 95% CI 0.24-0.63, P<.001), and hypertension medication adherence (β=–0.32, 95% CI –0.62 to –0.03, P=.03). Models explained only a small amount of the variance in health behaviors. Conclusions: Given the promising, although modest, associations between online health information–seeking behaviors and some health behaviors, efforts are needed to improve Hispanics’ ability to access and understand health information and to enhance the availability of online health information that is suitable in terms of language, readability level, and cultural relevance. %M 26611438 %R 10.2196/jmir.4368 %U http://www.jmir.org/2015/11/e261/ %U https://doi.org/10.2196/jmir.4368 %U http://www.ncbi.nlm.nih.gov/pubmed/26611438 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e209 %T Who Uses the Internet as a Source of Nutrition and Dietary Information? An Australian Population Perspective %A Pollard,Christina Mary %A Pulker,Claire Elizabeth %A Meng,Xingqiong %A Kerr,Deborah Anne %A Scott,Jane Anne %+ School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth, WA 6845, Australia, 61 892661142, C.Pollard@curtin.edu.au %K information seeking behavior %K Internet %K media, social %K behavior, eating food habits %K public health practice %K nutrition %K food, diet, Western %D 2015 %7 26.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet contains a plethora of nutrition information. Health organizations are increasingly using the Internet to deliver population-wide health information and interventions. Effective interventions identify their target population and their needs; however, little is known about use of the Internet as a source of nutrition information. Objective: The aim was to assess the change in prevalence and demographic characteristics of Western Australian adults accessing the Internet as a source of nutrition information and identify specific information needs. Methods: Data were pooled from the Western Australian Department of Health’s 3-yearly Nutrition Monitoring Survey Series telephone survey between 1995 and 2012 of 7044 participants aged 18 to 64 years. Outcome variables were the main sources of nutrition information used in the last year and yes/no responses to 4 suggestions to what would make it easier to eat a healthy diet. Sociodemographic variables were collected. Results: The proportion of respondents using the Internet for nutrition information increased from <1% in 1995-2001 to 9.1% in 2004 and 33.7% in 2012. Compared to 2004, logistic regression showed that the odds of using the Internet for this information increased significantly in 2009 (OR 2.84, 95% CI 2.07-3.88) and 2012 (OR 5.20, 95% CI 3.86-7.02, P<.001). Respondents using the Internet as a source were more likely to be female (OR 1.30, 95% CI 1.05-1.60, P=.02), live in a metropolitan area (OR 1.26, 95% CI 1.03-1.54, P=.03), born in countries other than Australia/UK/Ireland (OR 1.41, 95% CI 1.07-1.85, P=.02), more educated (university: OR 2.46, 95% CI 1.77-3.42, P<.001), and were less likely to be older (55-64 years: OR 0.38, 95% CI 0.25-0.57, P<.001). The majority of respondents agreed the following information would assist them to make healthier choices: more ways to prepare healthy foods (72.0%, 95% CI 70.7-73.3), quicker ways to prepare healthy foods (79.0%, 95% CI 77.8-80.1), how to choose healthy foods (68.8%, 95% CI 67.5-70.1), and knowing more about cooking (54.7%, 95% CI 53.3-56.1). Those using the Internet for nutrition information were more likely than nonusers to want to know quicker ways to prepare healthy foods (83.0% vs 78.1%, P=.005) and information on choosing healthy foods (76.3% vs 67.3%, P<.001). Conclusions: Use of the Internet as a main source of nutrition information has grown rapidly since 2004; one-third of Western Australian adults reported using the Internet for this purpose in 2012. Information on preparing healthy foods (ideas, quicker ways), choosing ingredients, and knowing more about cooking would make it easier to eat a healthy diet. For Internet users, emphasis should be on quicker ways and choosing ingredients. These finding have implications for policy makers and practitioners and suggest that traditional health promotion tactics should continue to be used to reach the broader population. %M 26310192 %R 10.2196/jmir.4548 %U http://www.jmir.org/2015/8/e209/ %U https://doi.org/10.2196/jmir.4548 %U http://www.ncbi.nlm.nih.gov/pubmed/26310192 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e204 %T Analyzing Information Seeking and Drug-Safety Alert Response by Health Care Professionals as New Methods for Surveillance %A Callahan,Alison %A Pernek,Igor %A Stiglic,Gregor %A Leskovec,Jure %A Strasberg,Howard R %A Shah,Nigam Haresh %+ Stanford Center for Biomedical Informatics Research, Stanford University, Room X-215, 1265 Welch Road, Stanford, CA, 94305-5479, United States, 1 6507236979, acallaha@stanford.edu %K Internet log analysis %K data mining %K physicians %K information-seeking behavior %K drug safety surveillance %D 2015 %7 20.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Patterns in general consumer online search logs have been used to monitor health conditions and to predict health-related activities, but the multiple contexts within which consumers perform online searches make significant associations difficult to interpret. Physician information-seeking behavior has typically been analyzed through survey-based approaches and literature reviews. Activity logs from health care professionals using online medical information resources are thus a valuable yet relatively untapped resource for large-scale medical surveillance. Objective: To analyze health care professionals’ information-seeking behavior and assess the feasibility of measuring drug-safety alert response from the usage logs of an online medical information resource. Methods: Using two years (2011-2012) of usage logs from UpToDate, we measured the volume of searches related to medical conditions with significant burden in the United States, as well as the seasonal distribution of those searches. We quantified the relationship between searches and resulting page views. Using a large collection of online mainstream media articles and Web log posts we also characterized the uptake of a Food and Drug Administration (FDA) alert via changes in UpToDate search activity compared with general online media activity related to the subject of the alert. Results: Diseases and symptoms dominate UpToDate searches. Some searches result in page views of only short duration, while others consistently result in longer-than-average page views. The response to an FDA alert for Celexa, characterized by a change in UpToDate search activity, differed considerably from general online media activity. Changes in search activity appeared later and persisted longer in UpToDate logs. The volume of searches and page view durations related to Celexa before the alert also differed from those after the alert. Conclusions: Understanding the information-seeking behavior associated with online evidence sources can offer insight into the information needs of health professionals and enable large-scale medical surveillance. Our Web log mining approach has the potential to monitor responses to FDA alerts at a national level. Our findings can also inform the design and content of evidence-based medical information resources such as UpToDate. %M 26293444 %R 10.2196/jmir.4427 %U http://www.jmir.org/2015/8/e204/ %U https://doi.org/10.2196/jmir.4427 %U http://www.ncbi.nlm.nih.gov/pubmed/26293444 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e196 %T Association of Online Health Information–Seeking Behavior and Self-Care Activities Among Type 2 Diabetic Patients in Saudi Arabia %A Jamal,Amr %A Khan,Samina A %A AlHumud,Ahmed %A Al-Duhyyim,Abdulaziz %A Alrashed,Mohammed %A Bin Shabr,Faisal %A Alteraif,Alwalid %A Almuziri,Abdullah %A Househ,Mowafa %A Qureshi,Riaz %+ College of Medicine, Family and Community Medicine Department, King Saud University, POBox 90714, Riyadh, 11623, Saudi Arabia, 966 114690822, amrjamal@ksu.edu.sa %K Internet %K diabetes mellitus, type 2 %K self-care %K consumer health information %K telemedicine %K medical informatics %K health education %K Google %K eHealth %K e-patients %K health behavior %K Middle East %K Saudi Arabia %D 2015 %7 12.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Health information obtained from the Internet has an impact on patient health care outcomes. There is a growing concern over the quality of online health information sources used by diabetic patients because little is known about their health information–seeking behavior and the impact this behavior has on their diabetes-related self-care, in particular in the Middle East setting. Objective: The aim of this study was to determine the online health-related information–seeking behavior among adult type 2 diabetic patients in the Middle East and the impact of their online health-related information–seeking behavior on their self-care activities. Methods: A cross-sectional survey was conducted on 344 patients with type 2 diabetes attending inpatient and outpatient primary health care clinics at 2 teaching hospitals in Riyadh, Saudi Arabia. The main outcome measures included the ability of patients to access the Internet, their ability to use the Internet to search for health-related information, and their responses to Internet searches in relation to their self-care activities. Further analysis of differences based on age, gender, sociodemographic, and diabetes-related self-care activities among online health-related information seekers and nononline health-related information seekers was conducted. Results: Among the 344 patients, 74.1% (255/344) were male with a mean age of 53.5 (SD 13.8) years. Only 39.0% (134/344) were Internet users; 71.6% (96/134) of them used the Internet for seeking health-related information. Most participants reported that their primary source of health-related information was their physician (216/344, 62.8%) followed by television (155/344, 45.1%), family (113/344, 32.8%), newspapers (100/344, 29.1%), and the Internet (96/344, 27.9%). Primary topics participants searched for were therapeutic diet for diabetes (55/96, 57%) and symptoms of diabetes (52/96, 54%) followed by diabetes treatment (50/96, 52%). Long history of diabetes, familial history of the disease, unemployment, and not seeking diabetes education were the most common barriers for online health-related information–seeking behavior. Younger age, female, marital status, higher education, higher income, and longer duration of Internet usage were associated with more online health-related information–seeking behaviors. Most (89/96, 93%) online health-related information seekers reported positive change in their behaviors after seeking online health information. Overall odds ratio (OR 1.56, 95% CI 0.63-3.28) for all self-care responses demonstrated that there was no statistically significant difference between those seeking health-related information online and non–health-related information seekers. However, health-related information seekers were better in testing their blood glucose regularly, taking proper action for hyperglycemia, and adopting nonpharmacological management. Conclusions: Physicians and television are still the primary sources of health-related information for adult diabetic patients in Saudi Arabia whether they seek health-related information online or not. This study demonstrates that participants seeking online health-related information are more conscious about their diabetes self-care compared to non–health-related information seekers in some aspects more than the others. %M 26268425 %R 10.2196/jmir.4312 %U http://www.jmir.org/2015/8/e196/ %U https://doi.org/10.2196/jmir.4312 %U http://www.ncbi.nlm.nih.gov/pubmed/26268425 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e173 %T Characterizing the Processes for Navigating Internet Health Information Using Real-Time Observations: A Mixed-Methods Approach %A Perez,Susan L %A Paterniti,Debora A %A Wilson,Machelle %A Bell,Robert A %A Chan,Man Shan %A Villareal,Chloe C %A Nguyen,Hien Huy %A Kravitz,Richard L %+ Betty Irene Moore School of Nursing, University of California, Davis, 2103 Stockton Blvd, Sacramento, CA, 95817, United States, 1 5308488011, susan.perez@gmail.com %K dual processing %K information seeking %K Internet search %K health information %D 2015 %7 20.07.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about the processes people use to find health-related information on the Internet or the individual characteristics that shape selection of information-seeking approaches. Objective: Our aim was to describe the processes by which users navigate the Internet for information about a hypothetical acute illness and to identify individual characteristics predictive of their information-seeking strategies. Methods: Study participants were recruited from public settings and agencies. Interested individuals were screened for eligibility using an online questionnaire. Participants listened to one of two clinical scenarios—consistent with influenza or bacterial meningitis—and then conducted an Internet search. Screen-capture video software captured Internet search mouse clicks and keystrokes. Each step of the search was coded as hypothesis testing (etiology), evidence gathering (symptoms), or action/treatment seeking (behavior). The coded steps were used to form a step-by-step pattern of each participant’s information-seeking process. A total of 78 Internet health information seekers ranging from 21-35 years of age and who experienced barriers to accessing health care services participated. Results: We identified 27 unique patterns of information seeking, which were grouped into four overarching classifications based on the number of steps taken during the search, whether a pattern consisted of developing a hypothesis and exploring symptoms before ending the search or searching an action/treatment, and whether a pattern ended with action/treatment seeking. Applying dual-processing theory, we categorized the four overarching pattern classifications as either System 1 (41%, 32/78), unconscious, rapid, automatic, and high capacity processing; or System 2 (59%, 46/78), conscious, slow, and deliberative processing. Using multivariate regression, we found that System 2 processing was associated with higher education and younger age. Conclusions: We identified and classified two approaches to processing Internet health information. System 2 processing, a methodical approach, most resembles the strategies for information processing that have been found in other studies to be associated with higher-quality decisions. We conclude that the quality of Internet health-information seeking could be improved through consumer education on methodical Internet navigation strategies and the incorporation of decision aids into health information websites. %M 26194787 %R 10.2196/jmir.3945 %U http://www.jmir.org/2015/7/e173/ %U https://doi.org/10.2196/jmir.3945 %U http://www.ncbi.nlm.nih.gov/pubmed/26194787 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e85 %T The Prevalence of Online Health Information Seeking Among Patients in Scotland: A Cross-Sectional Exploratory Study %A Moreland,Julia %A French,Tara L %A Cumming,Grant P %+ University of the Highlands and Islands, Moray College, Moray Street, Elgin, , United Kingdom, 44 01343576000, julia.moreland.moray@uhi.ac.uk %K online health information seeking %K health care-seeking behavior %K health information seeking %K health seeking %K digital divide %D 2015 %7 15.07.2015 %9 Original Paper %J JMIR Res Protoc %G English %X 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. %M 26177562 %R 10.2196/resprot.4010 %U http://www.researchprotocols.org/2015/3/e85/ %U https://doi.org/10.2196/resprot.4010 %U http://www.ncbi.nlm.nih.gov/pubmed/26177562 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 3 %P e15 %T What Kind of Information About Marginal Donors Is Available Through Sources Other Than Health Care Professionals for Patients on the Waiting List for Organ Transplantation? %A Kamran,Sara %A Calmus,Yvon %A Pomey,Marie Pascale %A Vidal-Trécan,Gwenaëlle %+ Paris Center University Hospitals, Public Health ward: Quality and Risk Management, Assistance Publique - Hôpitaux de Paris, 27, rue du faubourg Saint Jacques, Paris, 75014, France, 33 158412050, sara.kamran@cch.aphp.fr %K access to information %K marginal donor %K online health information %K health information exchange %K organ transplantation %K lung %K liver %K kidney %K heart %D 2015 %7 14.07.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: The current organ shortage has necessitated expanding the criteria for potential donations to marginal donors (older or sick donors whose organs would have been considered unsuitable before). In France, physicians are not required to provide information to recipients about marginal donors except for hepatitis C or hepatitis B infection and non-heart-beating donations. We hypothesized that patients can be informed about these risks by other information sources than health care professionals, such as websites and patient associations. Objective: The objectives of the study were to identify the main health information sources of transplant patients other than health professionals and to evaluate the information provided by websites and associations to patients about the risks of transplantation from marginal donors. Methods: In this study, the information sources for kidney, liver, heart, and lung patients that had already received transplants or registered on waiting lists were identified by a survey in four transplant centers. Further, the information proposed by French and English language websites and patient associations were evaluated, respectively, by a systematic review of websites and a survey among the presidents of kidney, liver, heart, and lung patient associations. Results: For the first survey, (367/402) 91.3% responses were registered. Apart from health professionals identified as the principal information source (363/367) 98.9%, 19 liver and 28 heart patients searched for information on the websites, while 37 kidney and 42 lung patients were more informed by patients’ associations. Our two last surveys showed that information about marginal donors is accessible by websites and (10/34) 30% of associations. All of the 60 Internet documents evaluated on French language and English language websites proposed information about marginal donors. Otherwise, (52/65) 80% of these documents were dedicated to health professionals and contained specialized information, difficult to understand by patients. Certain associations, (20/34) 59%, provided information about the risks of transplantation. There were 45/115 patients considering associations as their main information source that were informed by an association’s website. However, only (5/22) 23% of associations communicated the risks of transplantation with patients through their websites. Conclusions: Currently, patients want to be more informed by other information sources than health professionals, particularly by the websites. Nevertheless, they cannot always trust information proposed by these sources. They need to have their physicians inform them about specialized keywords and present them with reliable information sources. So reliable centers such as universities, transplant centers, and associations should develop the quality and quantity of information proposed to patients on their websites. %M 26175096 %R 10.2196/ijmr.4301 %U http://www.i-jmr.org/2015/3/e15/ %U https://doi.org/10.2196/ijmr.4301 %U http://www.ncbi.nlm.nih.gov/pubmed/26175096 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 3 %P e25 %T Analysis of PubMed User Sessions Using a Full-Day PubMed Query Log: A Comparison of Experienced and Nonexperienced PubMed Users %A Yoo,Illhoi %A Mosa,Abu Saleh Mohammad %+ Department of Health Management and Informatics, School of Medicine, University of Missouri, Five Hospital Dr., CE718 Clinical Support and Education Building (DC006.00), Columbia, MO, 65212, United States, 1 573 882 7642, yooil@health.missouri.edu %K PubMed %K MEDLINE %K information retrieval %K experienced users %K nonexperienced users %K PubMed query log %D 2015 %7 02.07.2015 %9 Original Paper %J JMIR Med Inform %G English %X Background: PubMed is the largest biomedical bibliographic information source on the Internet. PubMed has been considered one of the most important and reliable sources of up-to-date health care evidence. Previous studies examined the effects of domain expertise/knowledge on search performance using PubMed. However, very little is known about PubMed users’ knowledge of information retrieval (IR) functions and their usage in query formulation. Objective: The purpose of this study was to shed light on how experienced/nonexperienced PubMed users perform their search queries by analyzing a full-day query log. Our hypotheses were that (1) experienced PubMed users who use system functions quickly retrieve relevant documents and (2) nonexperienced PubMed users who do not use them have longer search sessions than experienced users. Methods: To test these hypotheses, we analyzed PubMed query log data containing nearly 3 million queries. User sessions were divided into two categories: experienced and nonexperienced. We compared experienced and nonexperienced users per number of sessions, and experienced and nonexperienced user sessions per session length, with a focus on how fast they completed their sessions. Results: To test our hypotheses, we measured how successful information retrieval was (at retrieving relevant documents), represented as the decrease rates of experienced and nonexperienced users from a session length of 1 to 2, 3, 4, and 5. The decrease rate (from a session length of 1 to 2) of the experienced users was significantly larger than that of the nonexperienced groups. Conclusions: Experienced PubMed users retrieve relevant documents more quickly than nonexperienced PubMed users in terms of session length. %M 26139516 %R 10.2196/medinform.3740 %U http://medinform.jmir.org/2015/3/e25/ %U https://doi.org/10.2196/medinform.3740 %U http://www.ncbi.nlm.nih.gov/pubmed/26139516 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e81 %T Mapping Publication Trends and Identifying Hot Spots of Research on Internet Health Information Seeking Behavior: A Quantitative and Co-Word Biclustering Analysis %A Li,Fan %A Li,Min %A Guan,Peng %A Ma,Shuang %A Cui,Lei %+ Department of Medical Informatics, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China, 86 24 31939518, cmuinfo@163.com %K information seeking behavior %K Internet %K health information %K bibliometric analysis %K co-word analysis %K biclustering %K hot spots %K publication status %D 2015 %7 25.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet has become an established source of health information for people seeking health information. In recent years, research on the health information seeking behavior of Internet users has become an increasingly important scholarly focus. However, there have been no long-term bibliometric studies to date on Internet health information seeking behavior. Objective: The purpose of this study was to map publication trends and explore research hot spots of Internet health information seeking behavior. Methods: A bibliometric analysis based on PubMed was conducted to investigate the publication trends of research on Internet health information seeking behavior. For the included publications, the annual publication number, the distribution of countries, authors, languages, journals, and annual distribution of highly frequent major MeSH (Medical Subject Headings) terms were determined. Furthermore, co-word biclustering analysis of highly frequent major MeSH terms was utilized to detect the hot spots in this field. Results: A total of 533 publications were included. The research output was gradually increasing. There were five authors who published four or more articles individually. A total of 271 included publications (50.8%) were written by authors from the United States, and 516 of the 533 articles (96.8%) were published in English. The eight most active journals published 34.1% (182/533) of the publications on this topic. Ten research hot spots were found: (1) behavior of Internet health information seeking about HIV infection or sexually transmitted diseases, (2) Internet health information seeking behavior of students, (3) behavior of Internet health information seeking via mobile phone and its apps, (4) physicians’ utilization of Internet medical resources, (5) utilization of social media by parents, (6) Internet health information seeking behavior of patients with cancer (mainly breast cancer), (7) trust in or satisfaction with Web-based health information by consumers, (8) interaction between Internet utilization and physician-patient communication or relationship, (9) preference and computer literacy of people using search engines or other Web-based systems, and (10) attitude of people (especially adolescents) when seeking health information via the Internet. Conclusions: The 10 major research hot spots could provide some hints for researchers when launching new projects. The output of research on Internet health information seeking behavior is gradually increasing. Compared to the United States, the relatively small number of publications indexed by PubMed from other developed and developing countries indicates to some extent that the field might be still underdeveloped in many countries. More studies on Internet health information seeking behavior could give some references for health information providers. %M 25830358 %R 10.2196/jmir.3326 %U http://www.jmir.org/2015/3/e81/ %U https://doi.org/10.2196/jmir.3326 %U http://www.ncbi.nlm.nih.gov/pubmed/25830358 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e79 %T “It’s Got to Be on This Page”: Age and Cognitive Style in a Study of Online Health Information Seeking %A Agree,Emily M %A King,Abby C %A Castro,Cynthia M %A Wiley,Adrienne %A Borzekowski,Dina LG %+ Johns Hopkins University, Departments of Sociology and Population, Family, and Reproductive Health, 530 Mergenthaler hall, 3400 North Charles Street, Baltimore, MD, 21218, United States, 1 410 516 5832, emily.agree@jhu.edu %K eHealth %K Internet %K health literacy %K age groups %K field dependence-independence %D 2015 %7 24.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The extensive availability of online health information offers the public opportunities to become independently informed about their care, but what affects the successful retrieval and understanding of accurate and detailed information? We have limited knowledge about the ways individuals use the Internet and the personal characteristics that affect online health literacy. Objective: This study examined the extent to which age and cognitive style predicted success in searching for online health information, controlling for differences in education, daily Internet use, and general health literacy. Methods: The Online Health Study (OHS) was conducted at Johns Hopkins School of Public Health and Stanford University School of Medicine from April 2009 to June 2010. The OHS was designed to explore the factors associated with success in obtaining health information across different age groups. A total of 346 men and women aged 35 years and older of diverse racial and ethnic backgrounds participated in the study. Participants were evaluated for success in searching online for answers to health-related tasks/questions on nutrition, cancer, alternative medicine, vaccinations, medical equipment, and genetic testing. Results: Cognitive style, in terms of context sensitivity, was associated with less success in obtaining online health information, with tasks involving visual judgment most affected. In addition, better health literacy was positively associated with overall success in online health seeking, specifically for tasks requiring prior health knowledge. The oldest searchers were disadvantaged even after controlling for education, Internet use, general health literacy, and cognitive style, especially when spatial tasks such as mapping were involved. Conclusions: The increasing availability of online health information provides opportunities to improve patient education and knowledge, but effective use of these resources depends on online health literacy. Greater support for those who are in the oldest cohorts and for design of interfaces that support users with different cognitive styles may be required in an age of shared medical decision making. %M 25831483 %R 10.2196/jmir.3352 %U http://www.jmir.org/2015/3/e79/ %U https://doi.org/10.2196/jmir.3352 %U http://www.ncbi.nlm.nih.gov/pubmed/25831483 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 1 %P e16 %T Effects of Individual Health Topic Familiarity on Activity Patterns During Health Information Searches %A Puspitasari,Ira %A Moriyama,Koichi %A Fukui,Ken–ichi %A Numao,Masayuki %+ The Institute of Scientific and Industrial Research, Osaka University, Mihogaoka 8-1, Ibaraki, 567-0047, Japan, 81 6 68798426, ira@ai.sanken.osaka-u.ac.jp %K health information search %K health search activity pattern %K health topic familiarity %K sequence of search activities %D 2015 %7 17.03.2015 %9 Original Paper %J JMIR Med Inform %G English %X Background: Non-medical professionals (consumers) are increasingly using the Internet to support their health information needs. However, the cognitive effort required to perform health information searches is affected by the consumer’s familiarity with health topics. Consumers may have different levels of familiarity with individual health topics. This variation in familiarity may cause misunderstandings because the information presented by search engines may not be understood correctly by the consumers. Objective: As a first step toward the improvement of the health information search process, we aimed to examine the effects of health topic familiarity on health information search behaviors by identifying the common search activity patterns exhibited by groups of consumers with different levels of familiarity. Methods: Each participant completed a health terminology familiarity questionnaire and health information search tasks. The responses to the familiarity questionnaire were used to grade the familiarity of participants with predefined health topics. The search task data were transcribed into a sequence of search activities using a coding scheme. A computational model was constructed from the sequence data using a Markov chain model to identify the common search patterns in each familiarity group. Results: Forty participants were classified into L1 (not familiar), L2 (somewhat familiar), and L3 (familiar) groups based on their questionnaire responses. They had different levels of familiarity with four health topics. The video data obtained from all of the participants were transcribed into 4595 search activities (mean 28.7, SD 23.27 per session). The most frequent search activities and transitions in all the familiarity groups were related to evaluations of the relevancy of selected web pages in the retrieval results. However, the next most frequent transitions differed in each group and a chi-squared test confirmed this finding (P<.001). Next, according to the results of a perplexity evaluation, the health information search patterns were best represented as a 5-gram sequence pattern. The most common patterns in group L1 were frequent query modifications, with relatively low search efficiency, and accessing and evaluating selected results from a health website. Group L2 performed frequent query modifications, but with better search efficiency, and accessed and evaluated selected results from a health website. Finally, the members of group L3 successfully discovered relevant results from the first query submission, performed verification by accessing several health websites after they discovered relevant results, and directly accessed consumer health information websites. Conclusions: Familiarity with health topics affects health information search behaviors. Our analysis of state transitions in search activities detected unique behaviors and common search activity patterns in each familiarity group during health information searches. %M 25783222 %R 10.2196/medinform.3803 %U http://medinform.jmir.org/2015/1/e16/ %U https://doi.org/10.2196/medinform.3803 %U http://www.ncbi.nlm.nih.gov/pubmed/25783222 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 6 %P e181 %T Should Health Organizations Use Web 2.0 Media in Times of an Infectious Disease Crisis? An In-depth Qualitative Study of Citizens’ Information Behavior During an EHEC Outbreak %A van Velsen,Lex %A van Gemert-Pijnen,Julia E.W.C %A Beaujean,Desirée J.M.A %A Wentzel,Jobke %A van Steenbergen,Jim E %+ Center for eHealth Research and Disease Management, Department of Psychology, Health and Technology, University of Twente, P.O. box 217, Enschede, 7500 AE, Netherlands, 31 0534896054, l.s.vanvelsen@utwente.nl %K Disease Outbreaks %K Foodborne Diseases %K Health Communication %K Information Dissemination %K Information Seeking Behavior %K Social networking %D 2012 %7 20.12.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Web 2.0 media (eg, Facebook, Wikipedia) are considered very valuable for communicating with citizens in times of crisis. However, in the case of infectious disease outbreaks, their value has not been determined empirically. In order to be able to take full advantage of Web 2.0 media in such a situation, the link between these media, citizens’ information behavior, and citizens’ information needs has to be investigated. Objective: The goal of our study was to assess citizens’ Web 2.0 media use during an infectious disease outbreak and to determine which Web 2.0 medium is used for which goal. With this information, we wanted to formulate recommendations for health organizations that consider using Web 2.0 media as part of their communication strategy during an infectious disease outbreak. Methods: A total of 18 student participants kept an information diary for 4 weeks during the 2011 enterohemorrhagic E. coli (EHEC) outbreak in Germany. Of them, 9 lived at the epicenter of the outbreak and 9 of them at some distance. The diaries were supplemented by a qualitative pre-survey (demographics) and postsurvey (questioning their satisfaction with information provision during the outbreak). Results: The Internet appeared to be the most popular medium for passively receiving EHEC-related information, with news websites and websites of newspapers as the most consulted sources. Twitter was used for receiving information to a small degree, while Facebook played virtually no role. Participants indicated that they thought information posted on Twitter or Facebook was not reliable or was out of place. When actively seeking information, online newspapers and wikis were important sources. Several causes for (dis)satisfaction with information provision were uncovered: source credibility, contradicting messages, and a need for closure. Conclusions: During an infectious disease outbreak, our small sample of students did not see social media (like Facebook and Twitter) as suitable or reliable sources for communicating information, but primarily viewed them as a tool for communicating with friends. Wikis, however, did fill several information needs, especially when citizens are actively searching for information. For many, source credibility is an important asset of information usefulness. Finally, we provide several general recommendations for communicating with citizens during an infectious disease outbreak. %M 23257066 %R 10.2196/jmir.2123 %U http://www.jmir.org/2012/6/e181/ %U https://doi.org/10.2196/jmir.2123 %U http://www.ncbi.nlm.nih.gov/pubmed/23257066