Finding health information online continues to help patients understand new symptoms. However, incomplete information or advice that errs on the site of caution can cause distress or anxiety and prompt visits to a doctor. Cyberchondria, a new phenomenon, is defined as excessive compulsive searching for health information online that leads to distress and increase utilization of healthcare services. Grounded theory guided the conception of a mixed method study to investigate cyberchondria and symptom appraisal within Emergency Departments. A questionnaire and interviews were used to collect data from patients visiting a local Emergency Room. Results showed 63.3% of respondents looked up their symptoms online before their visit, and exhibited higher levels of cyberchondria and health anxiety than those who did not (p .001, p .004), and that health information consulted online can impact the decision to seek out immediate care. Strategies are needed to improve and promote quality online sources to benefit both seekers and services.

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Master of Science / Department of Journalism and Mass Communications / Joye C. Gordon / This experimental research adopts a typology of frames by Levin, Gaeth, and Schneider (1998) and seeks to a) determine what combination of attribute and goal frames produces the strongest effect on vaccination behavior; b) ascertain to what extent personal relevance of vaccination moderates this framing effect; and c) explore how individual pre-existing characteristics, such as recent vaccination history, vaccine risk perception, vaccine dread, and general attitude toward vaccination influence the persuasive power of framed messages. The study, designed as field experiment 2 (+/- attribute frame) x 2 (+/- goal frame) x 2(involvement), recruited 476 adult female participants that were exposed online to four experimental framing manipulations and a control condition. The main effect is consistent with the typology of frames — the combination of the positive attribute and the negative goal frame was the only condition that was significantly more persuasive than the control condition. Participants who had children or were pregnant, for whom vaccination was more relevant and meaningful, have not reacted to message framing differently. However, general pre-existing attitudes towards vaccines, perception of vaccine safety, perception of vaccine efficacy, vaccine dread, and vicarious experience with vaccine side effects, appear to be associated with antecedents of vaccination behavior. Overall, this study has focused on ecological validity,aiming at the applicability of framing theory in the context of health communication.

The purpose of the present study is to examine the pathways between gender and behavioral intention to engage in sexual HISB through application of the Theory of Planned Behavior (TPB). It was found that feminine and masculine gender role stress differentially influence perceived behavioral control and behavioral attitudes, and that intention to engage in HISB was higher among women than men. Attitudes and PBC significantly predicted behavioral intention in this model. Further, women in the sample were more likely to search for sexual health information, with online sources being the most frequently reported resource. Additionally, past HISB was a significant predictor of sexual health literacy, eHealth literacy, and sexual health knowledge. These findings indicate that gender role stress may play a role in the maintenance of attitudes and perceived behavioral control about sexual health information seeking behaviors, and that HISB in general is higher among women.

Background. Lung cancer is the leading cause of cancer deaths worldwide. Low survival rates have been attributed to delays to diagnosis, and some patients report having symptoms for several months before presenting to health services. Strategies are needed to encourage timely help-seeking. The Web is increasingly used as a health information source. Aim. The aim of this thesis is to explore whether the Web plays a role in help-seeking behaviour of people with lung cancer prior to diagnosis, and how the Web can be utilised to encourage earlier presentation to health services for symptomatic people. Systematic review. To begin, I carried out a systematic review of the literature (N=34), which highlighted a scarcity of research on Web use for symptom appraisal among cancer populations. Mixed-methods study. I conducted a survey with recently diagnosed (6 months or less) lung cancer patients (N=113). Based on survey responses, I purposively selected a sub-sample of patients and their family/friends ("proxies") for semi-structured interviews (N=33). In the survey, 20.4% of participants reported they or proxies had researched their condition online before the diagnosis. Interview results suggest perceived impacts of online information on symptom appraisal, forming the decision to seek help, and on interactions with healthcare professionals. Intervention development and evaluation. Based on my findings, I developed a Web-based intervention. The intervention provides tailored information about lung cancer, and uses components based on the Theory of Planned Behaviour ("TPB-components") to encourage earlier help-seeking. This intervention was tested in an online feasibility study (N=130), and subsequently in an online randomised controlled trial (N=212) with a factorial design to test main and interaction effects of tailoring and TPB-components. The feasibility study and first trial helped identify methodological issues which were addressed in a second trial with a mixed factorial design. This trial (N=253) indicated that the self-reported likelihood of visiting a doctor increased significantly by 11.8% from before to after viewing study information (p < 0.001), but no effects of tailoring or TPB-components were found. When examining only those aged ≥50 years, who are at highest risk of lung cancer, those receiving tailored information reported an increase of 13.2% in likelihood of seeking help, compared to 3.2% in the untailored group (p=0.01). Participants aged 50+ receiving the TPB-component reported a larger increase (13.8%) than those who did not receive the TPB-component (5.2%), but this did not meet the significance criterion (p=0.054). Conclusions. According to patients' perceptions, the Web can impact on processes in the appraisal, help-seeking and diagnostic interval leading up to diagnosis. Presentation of information about symptoms and risk factors online can produce significant effects on self-reported likelihood of seeking help. These findings indicate that there is potential for the Web to be utlised in the endeavour to educate the public about symptoms and to promote earlier presentation to health services, but due to small effects and differential dropout in this study, further research is required.

Trust for health care professionals (interpersonal trust) and the health care system (institutional trust) is imperative for the performance of health care systems. However, at the same time, contemporary societies today are characterised by decreasing levels of trust and citizens today are increasingly inclined to seek health information from sources beyond health care professionals. Sociologists have argued that societal institutions, such as the health care system, are subject to individuals’ increasing mistrust, which has created a “critical distance” between lay citizens and modern medicine. In this critical distance, the health care system and its representatives are continually questioned why citizens’ trust for the medical institution can not be taken for granted. Because individuals living in the modern society are more inclined to take control over their health by engaging in health information seeking behaviour, the present study aims to examine whether there exists an association between interpersonal and institutional trust and differences in health information seeking behaviour. This study focuses on the Swedish context, where decreasing levels of trust for societal institutions - including the health care system, have been reported. Multivariate logistic regression analysis using data from European Social Survey (2004) was utilised to answer the research questions “Is the degree of trust for the health care system in Sweden associated with individuals' health information seeking behaviours?” and “Is the degree of trust for health care professionals in Sweden associated with individuals' health information seeking behaviours?”. The majority of the results from this study were not statistically significant, why the null hypothesis can not be ruled out. More recently collected data and more representative operationalisations of variables might generate more valid results. The study topic provides a potentially fruitful and valuable route for future scientific research, why it is considered important to further investigate whether mistrust for the healthcare system and its experts motivates individuals to consult alternative sources rather than health care professionals when seeking health information.

My Thesis posits a novel method of utilizing emerging web semantics, through HTML5 markup; to improve experience of Health Information seekers through a framework for creating functional, tailored Health Information Resource Collections potentially hosted by their own Health Information Support Networks; and based upon long-standing principles of online Information Retrieval. Most such organizations have websites, with links to useful Resources. This research exemplifies how to design and to present the Resource Collections as pathfinders to existing online Health Information, adding context to each link, to directly address the needs of each community served. The research appeals to a Needs Analysis process rooted in Everyday Life Information Seeking research methodologies, especially Participatory Action Research. As a pilot project, the Needs Analysis focuses necessarily on the Spina Bifida & Hydrocephalus community – with which the author of the Thesis is intimately familiar as a person living with Hydrocephalus, making the choice of a Participatory Action Research framework ideal – and enlisted just one National (Canada) and one Regional (British Columbia) Association for the same rationale. Results of the Needs Analysis were used to identify necessary Resources, but also to select familiar web tools and technologies for design of the Resource Collection and Resource Cards. At completion, there is a functional Collection of Spina Bifida & Hydrocephalus Resources for researchers, caregivers, or patients with Spina Bifida and/or Hydrocephalus – not limited to members of any organization, but best suited by design to the two through which analysis was done. / Graduate

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The thesis aims to map the health information behaviour of parents. Behaviour of parents represents a significant part in the life of child and therefore the attention of this thesis is focused on this topic. Its theoretical part introduces the areas characterising the topic - information behaviour, models and process of information behaviour, health, health literacy and phenomena affecting information behaviour (such as advertisement in health service or information overload). The research part contains a methodological basis of work and describes the research design. In the final part, analytical results of the interviews are elaborated.