More and more parents are turning to the Internet for information about their children’s health and wellbeing. With all of the conflicting information online, how do parents decide which health websites to believe and follow? One website element the impact of which is not well understood is the readability level of content presented. An online survey was conducted with parents and university students in an attempt to isolate the relationships between website readability and credibility judgements and intentions to act. Parents and students were randomly assigned to view and evaluate one of three mock websites about Fragile X syndrome with identical content but differing readability levels. It was predicted that users would find websites that were easier to understand more credible and they would in turn then be more likely to act on the information from simple readability websites. Contrary to the author’s hypothesis, students were more likely to follow recommendations on websites written at a complex readability level, when they were engaged with the website. Results also showed that readability was less of an influence on credibility than were the parents’ pre-experiment knowledge of the disorder. / February 2017

Advances in information technology have made a significant influence on healthcare. Among technological breakthroughs, Internet has revolutionized the way people have access to health information. People increasingly use the Internet to search for, exchange and post health information on various types of websites. Internet offers invaluable benefits to its users; nevertheless, this very freedom to post information and the resulting enormous body of information is also one of the major sources of concerns. There have been misgivings about the quality of online health information since the Internet has been introduced. The 'top-down' approaches to control the quality of online health information proved to be neither practical nor desirable. The advent of web 2.0 (read and write version of web) enables user-driven approaches to improve the quality of information through 'bottom-up' approaches. The critical question is what type of bottom-up approach is suitable to provide online users with high quality health information. Drawing on the market design literature, this research proposes a framework to understand and address (improve) the problem of quality of online health information. The research aims to identify the conditions under which a market for exchange of online health information works efficiently and then study the mechanisms to achieve the efficiency conditions and maximise quality. It also highlights the literature gaps for designing an online market that ensure the quality of exchanged health information. The research collected data from question and answer platforms to carry the empirical analysis. One hundred actual question and answers from nine platforms (900 in total) were collected. The quality of health information was determined by medical expert assessors and related design features were collected form Internet. Statistical algorithmic modelling was adopted for data analysis. Supervised learning methods and mainly regression tree method was used to investigate the relationship between design and quality of health information. The study uncovers the mechanisms and design features that are associated with the quality of health information. It reveals the interaction between design features that lead to high quality health information. The results particularly highlight the importance of experts' participation in the platform for increasing health information quality. It also shed light on the importance of financial incentives in enhancing health information quality. Building on the empirical findings, the research proposes four design scenarios of an online health information market and their respective outcome in terms of quality. The research opens a new perspective for researchers on how to tackle the problem of quality of online health information by framing this problem as a 'market design' issue. It provides important design lessons for managers and designers on how to enhance the quality of online health information in their platforms. It gives policy makers empirically supported guidance for recognising and promoting online procedures that lead to production of high quality online health information.

Health communications providers strive to increase the health literacy of patients and care takers. Basic health literacy is a measure of a person’s ability to understand and act according to appropriate health information. The rise in the number of people attaining basic health literacy increases the amount of positive health behavior in the aggregate. Therefore, health communication providers can create a direct impact on tangible health results in a given population. The introduction of new technology has led to new ways of distributing health information, specifically through online media. Along with a new method of communication comes a need for a new way of evaluating it. As new media emerge and proliferate in the marketplace, different populations’ levels of health literacy become shaped in previously unpredictable ways. Current research suggests that significant differences in wealth and pervasive cultural features account for why distinct populations respond to these developments differently. Thus, the task of determining health communications’ success overall just got harder. It is now necessary to reassess health communications providers’ efficiency and effectiveness with regard to particular minority populations such as Hispanic/Latino adults. Throughout this paper, I refer to the Hispanic/Latino population’s unique characteristics as a case study for the derivation and application of universal health communication values. Thus, the purpose of this report is, based on current findings, to expose the primary values that describe and prescribe the efficacy of online health communication geared towards minorities such as Hispanic/Latino adults residing in the United States. This report concludes that the effectiveness of health information online is a function of three elements: access, quality, and communication strategy. Access represents the extent to which the intended user can search online for the sought-after health information, employ techniques to locate the intended information, and benefit from the search and comprehend the content. The quality prong of the health related Web content represents the useful indicia of accuracy and completeness of the information provided. The first two factors are a sine qua non for a robust health communication campaign. The communication strategy determines the audience reach and the relevance of the health message; both of which ultimately are the driving force for achieving lasting health behavior modification. Health information providers must periodically assess their services along the model’s benchmarks in order to achieve the highest possible levels of health literacy in their target populations and overall. Providers may engage in self-evaluation in order to gauge their own effectiveness, make improvements wherever necessary, and thereby ensure continued conformity to the aforementioned values. If/when these market players are unable or unwilling to adhere to this rubric, the public sphere may need to enforce it as a last resort. This paper does not investigate the merits of either public or private systems of governance; no matter how compliance is achieved, the modern promotion of optimal health literacy in minority communities (and hence, overall) requires that all three elements comprise a new, uniform model for online health communication initiatives. / text

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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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Today the amount of online medical information sources in Swedish is steadily increasing. The information is convenient and always at hand. People who turn to Google and other search engines are, however, not always knowledgeable about how to identify trustworthy information, or how search algorithms work. The main purpose of this study is to :ind out how Swedish students in the ages of 18-35 search for medical information online. One aspect of this is to gain a better understanding of how they navigate the internet, and how they prioritize and value different information sources. We also look at what sources they turn to for medical information and whether source credibility is crucial in their choices. Our study is based on an online survey at Umeå University. The survey was conducted among eight different study programs with students in the ages of 18-35. In total, we received 305 responses, of which 163 (53,4%) were women, 139 (45,6%) were men, and 1% de:ined as others. The main conclusion of this study is that the target group is most likely to turn to information sites provided by authorities. These sites are considered to be the most trustworthy. The study also showed that the target group was well aware of Sweden’s biggest online doctors, Kry in particular, and rated them as trustworthy as well. The target group would, however, not turn to these sites for medical information. We can also notice that the target group consider themselves to be critical of information online and good at evaluating source credibility.

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.

In the recent past, people were used to consult health care professionals or textbooks in order to find answer to health related questions. Now, the availability of medical information through electronic resources has changed people&lsquo / s information-seeking behaviors and, as a result, electronic information resources have become very popular and frequently used for health related searches. This study examines the online health information-seeking behaviors of middle aged and older people from Middle East Technical University and 100. Yil neighbourhood, specially demographic and other factors effecting online health information seeking, the types of sought online health information, assessment of the online health information, and reliability criteria of middle aged and older online health information seekers. A cross-sectional design was used to collect data. Self-administered questionnaires were distributed to participants. The final sample was 248 middle aged and older people. Findings show that middle aged and older employees from Middle East Technical University and 100. Yil neighbourhood are searching for health information especially for specific illnesses. They are using this information to self-treat or self-diagnose. Worse health conditions, expertise level in internet usage associates with searching behavior. Majority of the participants trust in information they found online but they do not share it with any health care professional.

The internet has radically changed the way people obtain and interact with information about diseases, treatments, and conditions. Yet, our understanding of how people access and use health information to make decisions- in other words, their health literacy- has not progressed. The overall aim of this thesis is to assess the extent to which health literacy is a valid and useful construct for policy and practice related to online health resources. A mixed-methods research programme of five studies was undertaken, influenced by realist evaluation methodology. First, to ascertain engagement with user-generated online health content (UGC) in the UK, analysis of a large European survey was undertaken. Then, the uncertainty regarding the relationship between health literacy and outcomes was addressed by a systematic review and qualitative analysis of health literacy measures. Results of these two studies informed interviews carried out with 13 'key informants': policymakers and primary care clinicians in the UK with a particular interest in health literacy and/or online information. A systematic review, incorporating a traditional narrative review and a realist review, evaluated existing trials addressing how effects of online resources vary by health literacy level. Finally, data were analysed from a feasibility randomized controlled trial, comparing usage and outcomes of accessing a 'personal experiences'-based asthma website (representing curated user-generated content) versus a 'facts and figures'-based website. Participant health literacy was assessed using an index identified from the systematic review of measures, and website usage was tracked. Approximately 25% of UK internet users engage with UGC at least monthly. The most frequent users were younger, more likely to be male, and to be carers for someone with a long-term illness. Three themes were identified from health literacy measurement: 'appropriate health decisions', 'ability to obtain healthcare services', and 'confidence'. Key informants noted the lack of clarity about how health literacy influences outcomes, and suggested that personal preferences and digital access and skills may be more relevant than health literacy for policy and practice. Existing trials of online resources in which participant health literacy was measured were mostly at high risk of bias; some possible explanations of how these interventions should work in people with low health literacy were that they may experience higher data entry burden related to chronic diseases, and that they may prefer simulated face-to-face communication. Finally, there were no differences between health literacy groups in the feasibility trial regarding usage or outcomes related to either the 'facts and figures' or 'personal experiences' websites. Taken together, these results question the validity and appropriateness of health literacy as a key objective or consideration in the development or use of online resources. While health literacy has value as a general idea, this thesis demonstrates that it may no longer be the right construct to guide intervention development and implementation to improve health outcomes.