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.

The internet has revolutionized the way people are able to seek information and express themselves. Many fields have been dramatically impacted by its occurrence and the health field is no exception. It is becoming increasingly popular to participate in online discussion forums centered on health-related topics. The goal of this research is to describe participants' experience of using an on-line forum focused on Chordoma, a rare form of cancer. Analysis of free-response questionnaires filled out by members of the forum, revealed four key themes: (a) the forum is a source of invaluable information, (b) the forum is a source for emotional support and hope, (c) members share a unique bond that often results in friendship, and (d) members' involvement changes over time. Benefits obtained by the users and implications for medical professionals are discussed. / Master of Science

Online Health Communities (OHCs) have become an important source of sharing and receiving information and support for people with health-related concerns. These communities provide important benefits to users including enhanced medical knowledge, emotional comfort, personal empowerment and the ability to create offline social connections. High levels of user engagement are beneficial to both users and the OHC, so it is important to understand what motivate users’ participation, encourage them to contribute and influence their churning behaviors. This thesis covers why, when, and how users are actively engaged within an OHC. It is based on descriptive and predictive analytics of OHC users’ online interactions with text mining techniques. I built explanatory models to reveal how users’ motivations and roles evolve over time, the types of social support activities that encourage users’ continuous participation, and the forms of social capital that drive users’ continued contributions to the community. In addition, I developed predictive models to help an OHC forecast whether and when a user will churn. The findings of this study have implications for managing and sustaining successful OHCs, and can provide OHC managers with suggestions on how to motivate user contributions and retain users through interventions.

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

When people access online health information, unfortunately, they have access to both clinically accurate and inaccurate information that they may then utilize to make informed personal health decisions. This research fills a gap in the literature of online health communities as they relate to chronic obstructive pulmonary disease (COPD). The conduct of this research required a multi-phased and multi-method approach, best presented in three distinct essays. In Essays 1 and 2, data gathering within two online health communities specific to COPD allowed this study to address three research questions: (1) what are the information needs of COPD patients that result in their participation in online health communities; (2) what are the information sources offered to the participants in these online communities; and (3) is the information obtained via those communities credible. Essay 1 harvested data from a moderated website hosted by a non-profit organization for patients with COPD and Essay 2 harvested data from a non-moderated Facebook group also serving this unique group. Data Miner, a Chrome extension designed to extract data, was used to collect data, key words and themes which brought an understanding of the health information needs of participants and identified what health information sources were preferred. Using NIH guidelines, the credibility of sources exchanged were evaluated for both groups. The research presented in Essay 1 showed that COPD patients have health information needs and that a clinically monitored social health online community, that is available 24/7 to answer questions that arise at the time of need, provides much needed support. The research in Essay 2 illustrates the need for healthcare workers to be aware of unmoderated sites and promote these sites for the purpose of socialization only, and not for medical information. Building on the knowledge gained through the data analysis in Essays 1 and 2 and based on the theoretical frameworks established in the health belief model, social exchange theory, and the technology acceptance model, Essay 3 generated a new integrated model that seeks to understand information seeking effectiveness in online health communities was proposed. This model identifies the relationships between the types of disease specific information sought by members of 65 COPD Facebook groups, and member success in acquiring credible and clinically accurate health information to use in making health decisions related to disease management and the development of effective health management behaviors. Structural equation modeling was utilized to analyze survey responses and test the proposed model for statistical significance This study has important implications for health educators and medical professionals that will enhance their understanding of the benefits of online peer health communities and will guide them in providing their patients with an "information prescription" guiding them to clinically accurate and understandable, disease specific health information between office visits and at the patient's time of need.

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Cognitive behavioural theory suggests that excessive use of the Internet for health purposes can contribute to health anxiety but previous research examining the relationship between health anxiety and health-related Internet use is limited. This thesis aimed to explore if and how health-related Internet utilization and health anxiety are related, and whether such Internet use can exacerbate the health anxiety of health anxious individuals. Study 1 aimed to examine the possible relationship between health anxiety and the extent of, reasons for, and effects of health-related Internet use in university students, using a bespoke, theory-based questionnaire. Results suggested that health anxiety was significantly related to heightened and potentially problematic health-related Internet use, including: more frequent use, a greater proportion of health (vs. non-health) information sought, more time spent online for health purposes, more searches for illness information, and heightened tension post-search. We also found correlations between health anxiety and six-items concerning possible Internet addiction for health purposes. Study 2 sought to obtain information about health anxious individuals’ perspectives on health-related Internet use, using qualitative methodology. Themes uncovered during analysis were consistent with the results of study 1, and highlighted several other aspects of health-related Internet use that were relevant to health anxious users, including: metacognitions, Internet disadvantages, and health anxiety for others etc. Study 3 used the results of studies 1 and 2 to develop and psychometrically evaluate a new Internet use questionnaire in a large, non-clinical sample. Results suggested that the measure was both valid and reliable. Spearman correlations and simultaneous regressions substantiated previous findings from our earlier studies. Three aspects of health- related Internet use were uniquely predictive of health anxiety (illness-related Internet use: self; problematic use of the Internet for health purposes; anxiety post-search/perceived adverse consequences of searching). Study 4 aimed to determine the effects of presenting online health information in a manner designed to facilitate disconfirmatory information processing on subsequent anxiety, worry and illness beliefs. Results suggested that facilitating disconfirmatory information in this way was ineffective in reducing negative emotional outcomes post-search. Study 5 compared the frequency of ‘query escalations’ (searches for common, benign symptoms escalating to the consideration of serious causes/diseases) during online health searches between high and low health anxious students. We also examined the participants’ rationale for escalating queries and the effects of escalating on anxiety. Results found instances of query escalation in both high and low health anxious groups; though high health anxious participants were more likely to escalate their queries. Both groups reported increased anxiety post-escalation. In the final chapter I briefly summarise our studies, discuss major findings and the implications of our research, critically appraise our methodology, choices, and studies, and make recommendations for future research in this area.

Thesis (D.P.H.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Introduction: How college undergraduates manage challenges with alcohol, drugs, tobacco, sex, stress, sleep, exercise, and diet can shape their current and future health habits and status. Health risk behaviors can result in outcomes that damage lives, threaten individual academic success, and jeopardize college retention. Online health education (e-Health) is an emerging intervention modality that offers cost-effective mass delivery of health information, with the potential for broad benefits. Questions remain regarding levels of student engagement with e-Health programs and the influence of demographic and personality traits on engagement. The purpose of this dissertation is to identify effective methods for measuring undergraduate engagement with health education websites and to assess differential website engagement and associated student characteristics. Methods: This study used a multi-method design involving all class years of full-and part-time students (18-24 years) at Wheaton College in Norton, Massachusetts. One hundred thirty-eight of the original209 study volunteers completed the baseline survey, accessed the study website, MyStudentBody (MSB), during the nine-week viewing period, and completed the post-engagement survey. Major categories of measurement included baseline measures of sociodemographic and psychobehavioral characteristics (predictor variables) and subsequent measures of website engagement including MSB utilization tracking data, and website engagement surveys (outcome variables). Cohorts of study and non-study students participated in post-study focus group discussions. Results: Findings showed rapidly declining website engagement over the nine-week access period and significant student non-engagement overall, despite regular use of incentive offers and email prompts. Quantitative findings showed no significant statistical associations between predictor and outcome measures. Qualitative data presented recurrent themes including factors that discouraged and encouraged participant e-Health program use. Conclusion: Further study is necessary to examine the potential predictors of undergraduate engagement in online health education. Study focus groups revealed patterns of student behaviors, beliefs, and preferences that can help explain content avoidance and point to student-centered strategies that can improve engagement in MSB and similar e-Health products. / 2031-01-01