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.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:694323 |
| Date | January 2016 |
| Creators | Skelly, Niamh |
| Contributors | Chew-Graham, Carolyn ; Brown, Richard |
| Publisher | University of Manchester |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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