High health anxiety has negative repercussions at the individual, interpersonal, and societal levels. According to cognitive behavioural theory, health anxiety is maintained, in part, by behavioural factors, termed safety behaviours. Health-related Internet use (HRIU) may be an important safety behaviour for some health anxious individuals. The Internet offers an abundance of health information, and opportunities to engage in health-related behaviours. Paper 1 aims to establish what is known about the relationship between health anxiety and HRIU. A systematic search was undertaken to identify studies that fell into five broad categories. The identified studies (N = 30) were then narratively reviewed, with an emphasis on methodological quality, and consideration also given to clinical implications and directions for future research. The review indicated that research to date has focused almost entirely on the relationship between health anxiety and using the Internet to obtain health information, termed online health research (OHR). Health anxiety appears associated with amount of, and emotional response to, OHR. The majority of existing studies are cross-sectional. Many use unvalidated measures of HRIU, and/or convenience samples recruited from universities or via commercial services. The Cyberchondria Severity Scale has potential clinical utility as a measure of a specific health anxiety maintenance cycle. However, there is a need for a more general instrument that can be used to assess various dimensions of HRIU in a validated manner. Paper 2 is a cross-sectional, correlational study of relationships between HRIU, health anxiety, and health service utilisation in a clinical, help-seeking sample. Participants were recruited from primary care practices, and completed questionnaire measures. Extent and nature of HRIU, and emotional and behavioural responses to HRIU, were measured using the Online Health Beliefs and Behaviour Inventory (OHBBI). The OHBBI is a recently developed measure that has undergone preliminary psychometric validation. OHBBI subscales explained 30% of variance in health anxiety, but did not improve prediction of self-reported service utilisation. A moderated regression indicated that the relationship between the Illness-Focused Searching subscale and health service utilisation varied as a function of health anxiety, with a negative relationship at low levels of health anxiety, and a positive relationship at high levels. This study provides further evidence of a role for HRIU in the maintenance of health anxiety, and advances the literature by using a validated measure of HRIU, a clinical sample, and well-controlled models. Paper 3 is a critical, reflective appraisal of the thesis as a whole. Methodological decisions, and their ramifications, are discussed in detail. The importance of the thesis is summarised, and implications for clinical practice and future research are revisited. The OHBBI requires further psychometric refinement. Longitudinal studies, and studies that use objective measures of service utilisation, are needed. Safety behaviours, including various forms of HRIU, may interact with each other to perpetuate health anxiety; such complex maintenance cycles merit empirical investigation.

Health organizations and governments are investing considerable resources into Internet-based health promotion. There is a large and growing body of research on health “etools” but to date most has been conducted using experimental paradigms; much less is known about those that are freely-available. Analysis was conducted of the data base generated through the operation of the freely-available health risk assessment (HRA) of the Heart and Stroke Foundation of Ontario. During the study period of February 1 to December 20, 2011, 147,274 HRAs were completed, of which 120,510 (79.8%) included consent for the use of information for research and were completed by adults aged 18 to 90 years. Comparison of Canadian users to national statistics confirmed that the HRA sample is not representative of the general population. The HRA sample is significantly and systematically biased by gender, education, employment, heath behaviours, and the prevalence of specific chronic diseases. Etool users may be a large but select segment of the population, those previously described as “Internet health information seekers.” Are all Internet health information seekers the same? To explore this issue, segmentation procedures available in common commercial packages (k-means clustering, two-step clustering, and latent class analysis) were conducted using five combinations of variables. Ten statistically significant solutions were created. The most robust solution divided the sample into four groups differentiated by age (two younger and two older groups) and healthiness, as reflected by disease and modifiable risk factor burden and readiness to make lifestyle changes. These groups suggest that while all users of online health etools may be health information seekers, they vary in the extent to which they are health oriented or health conscientious (i.e., engaging in preventive health behaviours or ready for behaviour change). It is hoped that this research will provide other organizations with similar data bases with a model for analyzing their client populations, therefore increasing our knowledge about health etool users.

Lau, Chun Hong. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 224-256). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Some appendixes in Chinese.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-08-08T11:31:32Z No. of bitstreams: 1 Sonia Maria da Silva Balão.pdf: 990062 bytes, checksum: d661de8299c0d3453ea314d82c5dbbd6 (MD5) / Made available in DSpace on 2018-08-08T11:31:32Z (GMT). No. of bitstreams: 1 Sonia Maria da Silva Balão.pdf: 990062 bytes, checksum: d661de8299c0d3453ea314d82c5dbbd6 (MD5) Previous issue date: 2018-06-20 / Nowadays, a great number of young people present themselves in clinic with complaints of a lonely and isolated personal life, with an affective-social withdrawal and impoverishment, sadness, hopelessness, anguish, internal guilt, helplessness, lack of will to live, cranky, self agressive and self-multilation behaviors. These factors, beyond worrying, point to pathology and to complex emotional difficulties. Another common feature of these young patients is to dedicate a lot of time to the virtual world instead of real life. On the social network, they have a group of lots of friends and dedicate a lot of their time with unknown people. This clear dissociation between the cloistered real life and the active virtual life demands questioning the social network role and think its excessive use as a way of psychological defense. Therefore, through the case study of a 16 years old young woman (when she begins the analysis), this research project proposes to understand this dissociation and its possible relation of the phenomenon to some psychopathology, specially depression, covering the contradictory way of the young people to have a depressive, apathetic and isolated existence in real life and manifest themselves vitally, interactively and intensely in social networks. The theorical basis of this investigation is the Winnicott’s Theory of Personal Maturity and the focus was on the articulation between the clinical case and the theory through the theoretical-methodological research and the research-listening. Reports from the patience, written by the psychologist during her three first years of psychological treatment and WhatsApp and Facebook messages given by the patience were all the valid corpus for this investigation. By avoiding contact with the loneliness that her illness aroused, the patient presented herself to treatment incapacitated to be alone and think about herself. Because of the lack of limits, she made use of the virtual world and isolated herself from shared reality. With psychic action from the analytic process, she started to stay connected to the cyber world while she needs, returning to the real world whenever she feels strengthened. Therefore, based on the analysis of the results of this clinical case, the use of communication in social networks by young depressive people is based on a paradox: the defense of the maniac type by the performance of the false self, to avoid depressive psychopathology, and, at the same time, the attempt to be cured by the new possibilities when the patient can experience the false self in consigning thru it the emersion of the true self / Atualmente, muitos jovens apresentam-se em consultório com queixas de uma vida pessoal solitária e isolada, com retraimento e empobrecimento afetivo-social, tristeza, desesperança, angústia, culpabilidade interna, desamparo, falta de vontade de viver e comportamentos irritadiços, autoagressivos e de automutilação, fatores esses que, além de preocupantes, apontam para uma possível patologia e para dificuldades emocionais complexas. Outra característica comum a esses jovens pacientes é dedicarem muito tempo ao mundo virtual em detrimento do real. Nas redes sociais, têm um grande grupo de amigos virtuais e dedicam muito tempo à interação com desconhecidos. Essa clara dissociação entre a vida real enclausurada e a vida virtual ativa impõe questionar o papel das redes sociais como uma forma de defesa psicológica. Frente a isso, a partir do estudo do caso clínico de uma jovem que, no início da análise, tinha 16 anos, esta pesquisa propõe compreender essa dissociação e a possível relação do fenômeno com alguma psicopatologia, em especial a depressão, abrangendo o modo contraditório dos jovens de ter um existir depressivo, apático e isolado na vida real e de se manifestarem de maneira vitalizada, interativa e intensa nas redes sociais. O fundamento teórico deste estudo é a Teoria do Amadurecimento Pessoal de Winnicott e o enfoque principal foi a articulação do caso clínico com a teoria por meio da pesquisa teórico-metodológica (pesquisa-investigação) e da pesquisa-escuta. Relatos da paciente anotados pela psicóloga em seus três primeiros anos de tratamento e mensagens de WhatsApp e de Facebook fornecidas pela paciente constituíram o corpus de base da pesquisa. Ao evitar contato com a solidão que seu adoecimento despertava, a paciente apresentou-se para tratamento incapaz de se manter sozinha e refletir sobre si mesma e, por não encontrar limites, fez uso patológico do mundo virtual, afastando-se da realidade compartilhada. Com a evolução psíquica a partir do processo analítico, ela passou a se conectar ao mundo cibernético dentro de sua necessidade, retornando ao mundo real sempre que se sentia fortalecida. Desse modo, a partir da análise desse caso clínico, chegou-se ao resultado de que o uso da comunicação nas redes sociais pelos jovens depressivos baseia-se num paradoxo: a defesa maníaca pela atuação do falso self, a fim de evitar o sofrimento da psicopatologia depressiva, e, ao mesmo tempo, a tentativa de cura por meio de novas experiências que o paciente pode vivenciar quando o falso self cede e consente a emersão do self verdadeiro

Desde o final do século XX, o tema saúde é um das mais procurados na internet para diversos fins. As pessoas que convivem com HIV/AIDS não estão afastadas dessa tendência, formando inclusive um dos grupos de usuários que mais acessam a internet. Um grupo com um passado e presente de produção de movimento social que muito contribuiu para a reconhecida política HIV/AIDS brasileira. O objetivo desta tese é identificar e analisar os padrões de busca e interação com o conteúdo em saúde na internet no cotidiano das pessoas com HIV/AIDS, em particular nos potenciais desdobramentos em processos de medicalização, tomada de decisão sobre condutas em saúde e relação com movimento social. A metodologia se baseou em análise de conteúdo de entrevistas e realização de etnografia virtual de uma página fechada no Facebook. As discussões sobre o material pesquisado foram divididas em categorias analíticas, cuja análise gerou os seguintes resultados: a sociabilidade produzida na internet contribui para diminuir o sofrimento em relação ao preconceito, tanto em relação ao HIV/AIDS, quanto à homossexualidade; há uma carência de espaços de acolhimento virtual em detrimento a uma maior oferta de espaços para discussão sobre políticas públicas; a medicalização na rede produz a chance de se obter condutas não recomendadas, no entanto, pessoas vinculadas a grupos virtuais possuem mais estímulos a não abandonar a medicação; a confiabilidade nos conteúdos da internet em geral possui um padrão de acesso a sites recomendados pelos órgãos oficiais do setor saúde; é comum pesquisar antes ou depois da consulta médica, no entanto a negociação se dá em cyberespaços de acolhimento; muitos ativistas do HIV/AIDS foram estimulados a participar do ativismo político através da internet. Há necessidade de se ampliar espaços virtuais de acolhimento através de políticas públicas incentivadoras; a formação médica precisa contemplar questões relacionadas à internet e saúde sobre sociabilidade, adesão, e terapêutica digital, prescrição de sites, blogs e redes sociais, devendo-se ponderar com questões de medicalização e prevenção quaternária. / Since the late twentieth century, health is one of the most popular subjects on the Internet for various reasons. People living with HIV/AIDS are not apart from this trend, being one of the groups of users with most intensive Internet access. This group is characterized by a intense participation in a social movement that greatly contributed to the acclaimed HIV/AIDS Brazilian policy. The objective of this thesis is to identify and analyze the search patterns and interaction with content on the Internet in the daily health of people with HIV/AIDS, particularly in potential developments in medicalization processes, decision making on health behaviors and relationship with social movements. The methodology involved interviews, which were later subject to content analysis, and a virtual ethnography of a closed secret group on Facebook. The discussion of the produced material was divided into analytical categories, whose analysis yielded the following results: sociability produced in the internet helps to reduce suffering in relation to prejudice, both with regard to HIV/AIDS and homosexuality; there are not many welcoming zones for people living with HIV and AIDS (PLHA) on the internet at the expense of a greater supply of spaces for discussion on public policy; medicalization produces opportunities to incur in unhealthy behaviors, however, people linked to social networks have more encouragement to not give up the medication; the reliability of internet content in general has a pattern of access to sites recommended by official agencies of the health sector; it is common to search before or after medical consultations, though negotiations about medication and symptoms take place in social networks; activists of HIV/AIDS were encouraged to participate in political activism over the internet. There is a need to have welcoming zones to PLHA on the internet guaranteed by public policy; medical education needs to cover issues related to the internet and health, such as sociability, compliance, and "digital therapy", prescription sites, blogs and social networks, but should consider issues of medicalization and quaternary prevention as well.

Desde o final do século XX, o tema saúde é um das mais procurados na internet para diversos fins. As pessoas que convivem com HIV/AIDS não estão afastadas dessa tendência, formando inclusive um dos grupos de usuários que mais acessam a internet. Um grupo com um passado e presente de produção de movimento social que muito contribuiu para a reconhecida política HIV/AIDS brasileira. O objetivo desta tese é identificar e analisar os padrões de busca e interação com o conteúdo em saúde na internet no cotidiano das pessoas com HIV/AIDS, em particular nos potenciais desdobramentos em processos de medicalização, tomada de decisão sobre condutas em saúde e relação com movimento social. A metodologia se baseou em análise de conteúdo de entrevistas e realização de etnografia virtual de uma página fechada no Facebook. As discussões sobre o material pesquisado foram divididas em categorias analíticas, cuja análise gerou os seguintes resultados: a sociabilidade produzida na internet contribui para diminuir o sofrimento em relação ao preconceito, tanto em relação ao HIV/AIDS, quanto à homossexualidade; há uma carência de espaços de acolhimento virtual em detrimento a uma maior oferta de espaços para discussão sobre políticas públicas; a medicalização na rede produz a chance de se obter condutas não recomendadas, no entanto, pessoas vinculadas a grupos virtuais possuem mais estímulos a não abandonar a medicação; a confiabilidade nos conteúdos da internet em geral possui um padrão de acesso a sites recomendados pelos órgãos oficiais do setor saúde; é comum pesquisar antes ou depois da consulta médica, no entanto a negociação se dá em cyberespaços de acolhimento; muitos ativistas do HIV/AIDS foram estimulados a participar do ativismo político através da internet. Há necessidade de se ampliar espaços virtuais de acolhimento através de políticas públicas incentivadoras; a formação médica precisa contemplar questões relacionadas à internet e saúde sobre sociabilidade, adesão, e terapêutica digital, prescrição de sites, blogs e redes sociais, devendo-se ponderar com questões de medicalização e prevenção quaternária. / Since the late twentieth century, health is one of the most popular subjects on the Internet for various reasons. People living with HIV/AIDS are not apart from this trend, being one of the groups of users with most intensive Internet access. This group is characterized by a intense participation in a social movement that greatly contributed to the acclaimed HIV/AIDS Brazilian policy. The objective of this thesis is to identify and analyze the search patterns and interaction with content on the Internet in the daily health of people with HIV/AIDS, particularly in potential developments in medicalization processes, decision making on health behaviors and relationship with social movements. The methodology involved interviews, which were later subject to content analysis, and a virtual ethnography of a closed secret group on Facebook. The discussion of the produced material was divided into analytical categories, whose analysis yielded the following results: sociability produced in the internet helps to reduce suffering in relation to prejudice, both with regard to HIV/AIDS and homosexuality; there are not many welcoming zones for people living with HIV and AIDS (PLHA) on the internet at the expense of a greater supply of spaces for discussion on public policy; medicalization produces opportunities to incur in unhealthy behaviors, however, people linked to social networks have more encouragement to not give up the medication; the reliability of internet content in general has a pattern of access to sites recommended by official agencies of the health sector; it is common to search before or after medical consultations, though negotiations about medication and symptoms take place in social networks; activists of HIV/AIDS were encouraged to participate in political activism over the internet. There is a need to have welcoming zones to PLHA on the internet guaranteed by public policy; medical education needs to cover issues related to the internet and health, such as sociability, compliance, and "digital therapy", prescription sites, blogs and social networks, but should consider issues of medicalization and quaternary prevention as well.