eHealth: Current Evidence, Promises, Perils and Future Directions: Volume 15

Cover of eHealth: Current Evidence, Promises, Perils and Future Directions

Table of contents

(13 chapters)

Purpose: Many Internet users search for health information but they struggle with assessing the quality of the information they find. By drawing on a multi-modal approach to data collection, this study aims to understand further the nuanced cognitive processes that people utilize as they acquire and evaluate online health information.

Design: We used a mixed-methods approach that includes surveys, interviews, and observations of 76 diverse adults of all ages in the Chicago area completing various health information-seeking tasks.

Findings: Most participants begin their information-seeking process on search engines. We identified the most popular credibility-assessment strategies used on the search engine results’ pages (SERP) as well as on websites. We also explored how the process of executing such strategies reveals greater and lesser savvy among users.

Research Limitations: While the sample size and methods limit its generalizability, this study included a larger and more diverse group of participants than most observational work, which results in data about a wider range of behaviors than is typical of such research.

Social Implications: Our findings showed that most of our participants could use additional education regarding credibility assessment of online health information. Additionally, since a great deal of credibility assessment occurs on SERP, search companies bear a particular responsibility for ensuring the quality of the information their results highlight.


Purpose: Previous research has found that people’s trust in a source of information affects whether they will expose themselves to information from that source, pay attention to that source, and the likelihood that they will act on the information obtained from that source. This study tracked trends in levels of trust in different health information sources over time and investigated sociodemographic predictors of trust in these sources.

Methodology/Approach: Data were drawn from the Health Information National Trends Survey (HINTS), a nationally representative, cross-sectional survey of adults in the USA. Weighted percentages, means, and standard errors for trust in health information sources were computed using data from four iterations of the survey (2005, 2009, 2012, and 2013). Weighted multivariable logistic regression models were employed to investigate associations between sociodemographic variables and level of trust in health information sources using HINTS 2013 data.

Findings: Trend analyses revealed declining trust in “traditional” mass media channels, such as television and radio, for health information and consistently high trust in interpersonal sources, like physicians, over the past decade. Regression analyses showed that those with more education (ORs 2.93–4.59, p < 0.05) and higher incomes (ORs 1.65–2.09, p < 0.05) were more likely to trust the Internet for health information than those with less education and lower incomes. Non-Hispanic Blacks and Hispanics were more likely to trust mass media channels in comparison to Non-Hispanic Whites (ORs 1.73–2.20, p < 0.05).

Implications: These findings can be used to inform the strategic selection of channels for disseminating health information to certain demographic groups.


Purpose: For deaf people who use American Sign Language (ASL), including cancer survivors, there are documented reports of difficulties in accessing and understanding health information. More than five years ago, a local breast cancer knowledge study with deaf signers found that only 23% of this sample cited the Internet as a source of health information. More research is needed to understand the current trends of a nationwide adult sample of deaf people’s experience with seeking and understanding health information across technology-mediated platforms.

Methodology/Approach: The Health Information National Trends Survey in American Sign Language survey included sections on health status, Internet use, and social media. We used several approaches to recruit deaf people across the USA, including Hawaii, Alaska, and Puerto Rico. The survey was administered online, in person, or through videophone. Following data cleaning, we conducted multiple logistic regression analyses, controlling for demographic factors associated with eHealth-seeking behaviors. The outcome variables of interest were Internet use and sharing health information on social media.

Findings: A total of 713 deaf people in USA (M = 49 years old; SD = 19) provided informed consent and took the survey. Half of the participants had a college degree. Twenty percent of the sample included those who self-identified as lesbian, gay, or bisexual and 38% who were people of color. White, educated, or younger deaf adults were more likely to cite the Internet as the first source of health information. Although all sub-groups were comparable in using social media, younger or ASL/English bilingual deaf adults were more likely to actively share health information through social media. While perceived trust in health information on the Internet did not differ across subgroups within the deaf sample, frustration in finding and understanding information was strongly linked to increasing age as well as those who prefer using ASL only. Users of YouTube for health-related information were likely to be younger or female.

Conclusions: Deaf users of eHealth information are diverse in terms of language usage, which affects their perception of accessing and using health information across technology-mediated platforms. While using YouTube for health appears to be accessible to deaf people, further improvements are needed to make health information sharing through social media inclusive of people who prefer ASL only. The addition of multimodal delivery features (text, audio, and video) in social networking sites has the strong potential to improve health information access and inclusion for all groups, including deaf ASL users. To make online health information inclusive of all groups, materials need to be accessible and easy to understand by all groups.


Purpose: This chapter examines how healthcare technologies (electronic medical records, personal cell phones, and pagers) help manage patient care work to accelerate processes of communication and blur boundaries between work time and non-work time, thereby revealing dynamics of power as indicated through temporal capital, or the amount of time under an individual’s control.

Method: The data were collected from 35 in-depth semistructured interviews of health practitioners, which included 26 physicians, 7 nurses, and 2 administrators.

Findings: Communication technologies fulfill promises of temporal autonomy and efficiency, but not without cost, particularly as it intersects with organizational/institutional power structures and non-work-related social factors such as pre-existing technological literacy and proficiency. The blurring of work and non-work time gives practitioners perceived higher quality of life while also increasing temporal flexibility and autonomy. The higher up one is in the relevant hierarchy, the more control one has over one’s own time, resulting in higher levels of temporal capital. The power hierarchies serve to complicate the potential recuperation of temporal capital by communication technologies.

Implications: This study uses a critical cultural perspective that takes into consideration structures of institutional power hierarches impact temporal organization through the use of communication technologies by health practitioners. Practitioner-facing research is particularly crucial given the high rates of burnout within the profession and concerns around the well-being of health practitioners, and autonomy and control over one’s time is a factor in work and life satisfaction.


Purpose: As biomedicine grants technology and quantification privileged roles in our cultural constructions of health, media and technology play an increasingly important role in mediating our everyday experiences of our bodies and may contribute to the reproduction of gendered norms.

Design: This study draws from a broad variety of disciplines to contextualize and interpret contemporary trends in self-quantification, focusing on metrics for health and fitness. I will also draw from psychology and feminist scholarship on objectification and body-surveillance.

Findings: I interpret body-tracking tools as biomedical technologies of self-surveillance that facilitate and encourage control of human bodies, while solidifying demands for standardization around neoliberal values of enhancement and optimization. I also argue that body-tracking devices reinforce and normalize the scrutiny of human bodies in ways that may reproduce and advance longstanding gender disparities in detriment of women.

Implications: A responsible conceptualization, design, implementation, and usage of health-tracking technologies requires us to recognize and better understand how technologies with widely touted benefits also have the potential to reinforce and extend inequalities, alter subjective experiences and produce damaging outcomes, especially among certain groups. I conclude by proposing some alternatives for devising technologies or encouraging practices that are sensitive to these differences and acknowledge the validity of alternative values.


Purpose: The primary purpose of this study is to examine the association between Internet use, skills, and health-related Internet activities, on the one hand, and perceived health outcomes of health-related Internet use, use of healthcare services, and self-rated health (SRH), on the other hand, the latter conceptualized as gains constituting the “third digital divide.” Secondarily, we seek to examine whether the above associations are maintained after accounting for demographic characteristics.

Methodology: A nationally representative random-digital-dial (RDD) telephone household survey of Israeli adult population (aged 21 and older, N = 819). The survey measured different dimensions of Internet use – frequency, experience, Web 1.0 general consumption and health-related activities, Web 2.0 production activities (general and health-related), and content evaluation. Potential health benefits included perceived outcomes of Internet use for health purposes, use of healthcare services and SRH.

Findings: In a multiple hierarchical regression model, adjusting for demographic variables, Internet use was associated with increased use of healthcare services and better perceived outcomes of Internet use for health purposes, but not with SRH.

Research Implications and Limitations: Health-related Internet use is associated with a sense of empowerment and enhanced use of healthcare services, but – after accounting for background variables – is not associated with SRH. Limitations include self-reports and a cross-sectional design, the latter precluding inference on causality.

Practical Implications: Internet use, specifically Web 1.0 consumption activities, is associated with increased use of healthcare services and is positively associated with perceived health outcomes. No such relationships were found for Web 2.0 activities. Future technological developments in services should take the digital divide into account and design products that will benefit disadvantaged groups.

Originality/Value: While rigorously assessing various dimensions of Internet use, the study distinguishes between various benefits of Internet use in the health domain, clarifying which benefits are associated with Internet use for health purposes.


Purpose: The issue of whether participation in online peer-support communities has positive or negative impacts on the psychological adjustment of cancer patients warrants further explorations from new perspectives. This research investigates the role of personality traits in moderating the impact of online participation on the psychological adjustment of cancer patients in terms of their general psychological well-being and cancer-specific well-being.

Methodology: Study participants consisted of adults diagnosed with leukemia. Questionnaires were collected from 111 participants in two leukemia-related forums in China, Baidu Leukemia Community and Bloodbbs. Information regarding the personality traits, online participation, and psychological adjustment were collected using an online questionnaire. A linear regression model was used to test the moderation effect of personality traits on the relationship between online participation and psychological adjustment.

Findings: The main effect of participation in online support communities on psychological adjustment was not statistically significant. Importantly, two personality traits (i.e., emotional stability and openness to experience) moderated the relationship between online participation and psychological adjustment to cancer. Leukemia patients with high emotional stability and high openness to experience reported better psychological adjustment as they participated more in the online community. However, this was not the case for patients with low stability and low openness, who reported worse psychological adjustment as their participation in the online support community increased.

Value: This study introduces two personality moderators into the discussion of how participation in online support communities influences the lives of cancer patients. The moderation effects help to explain why there have been contradictions in the findings of previous studies. In addition, this study adds to the current literature on online support communities as little research on this topic has been conducted outside of the US and Europe. Practically, this study not only highlights the need to evaluate the personality traits of patients who are recommended to participate in online communities, but also underlines the necessity of intervention in these communities.


Purpose: The aim of the study is to consider the use of the Internet as a potential facilitator of positive health-related perceptions. Specifically, we propose that online health information seeking fosters positive perceptions of health. Using path modeling, we theorized several mechanisms through which information seeking could be conducive to positive health perceptions, which we conceptualized into the following four dimensions: (1) sense of empowerment in managing health, (2) self-reported ability to take better care of health, (3) sense of improved health-related quality of life, and (4) self-reported improvement of health.

Methodology: Our sample consisted of respondents who have used the Internet as a resource for health information (n = 710), drawn from the largest national probability-based online research panel. Our comparison subsample consisted of older respondents (age ≥ 60; n = 194). We used Internet-specific measures and employed structural equation models (SEM) to estimate the direct, indirect, and total effects of health-related use of the Internet on subjective health perceptions. Based on our review of the literature, competent health communication with healthcare providers and sense of empowerment in managing personal health were modeled as mediator variables. We assessed whether the proposed mediational relationships, if significant, differed across our indicators of positive health perceptions and whether any differential associations were observed among older adults. We run parallel models for each indicator of positive health perception.

Findings: Provider-patient communication informed by the Internet resources were perceived to impart a greater sense of empowerment to manage health among our respondents, which in turn, was associated with perceived contributions to better self-reported ability to provide self-care, increased health-related quality of life, and improvement in self-reported health. The SEM results revealed a good fit with our full sample and subsample.

Research Implications: Conceptualization of the multidimensional aspects of online health information seeking with separate multi-indicator analyses of the outcome variable is important to further our understanding of how technology may impact the pathways involved in influencing health perceptions and as a result health outcomes.


Purpose: The public health burden caused by tobacco is heavy among first-generation Chinese immigrant men whose home country has significantly higher smoking rates than the United States. The current study is part of a larger effort to pilot an mHealth tobacco cessation intervention using MMS (graphic) mobile phone technologies to target East Asian immigrant populations. Grounded in the Extended Parallel Process Model (EPPM), our specific aims were to determine what message themes, level of graphic intensity, and types of efficacy information are most appropriate and useful for mHealth interventions targeting this population.

Methodology/Approach: A qualitative study utilizing a series of focus groups (k = 5) was conducted with male adult smokers who were born in China and currently reside in the United States. The primary aim of the focus groups was to solicit reactions to a series of preliminary messages developed by the research team. A secondary aim was to gauge receptivity to the use of MMS as a vehicle for smoking cessation intervention. Participants (n = 32) were recruited from local Chinese communities in a large Mid-Atlantic metropolitan area.

Findings: Opinions about different message strategies were mixed. However, participants tended to rate messages more positively when they focused on the impact of smoking on family and loved ones, particularly children. Messages with fear-arousing images were also perceived to be effective at low frequency of exposure, but there were concerns that they may backfire at high exposure. Awareness of and interest in Quitline were low, and concrete quitting tips were perceived as more effective. Participants reported a preference for receiving messages a few times a week, and an MMS message platform was generally preferred to WeChat (a Chinese social media platform).

Implications: Our results suggest that graphic MMS messaging holds promise as an effective intervention method for this population and that EPPM is an appropriate framework to develop, test, and analyze mHealth intervention messages. While messages that focused primarily on impact on children, health, and specific quitting tips were generally found to be more effective, a mix of different types of messages that address a wide range of issues may be most appropriate for this population.

Originality/Value: This study is the first to explore the utility of graphic text messaging as an intervention method to promote smoking cessation among male Chinese immigrants. Findings from the study provide important insights for future intervention work targeting this underserved population.


Purpose: Lesbian, gay, and bisexual (LGB) young adults smoke at rates much higher than the general population. Young adults, in general, are less likely to seek medical help for smoking cessation and LGB individuals are less likely to seek health care generally. Alternative methods to encourage smoking cessation are necessary. This research seeks to establish whether LGB young adults in California would be willing to use social media for smoking cessation.

Approach: We conducted 41 qualitative interviews among LGB young adults in the San Francisco Bay Area and Los Angeles in Fall 2014.

Findings: The results suggest that our participants were interested in a LGB-focused social media intervention, as long as the intervention was private or anonymous and moderated. Further, across topical areas our participants spoke extensively about the import of social connections. We may be able to leverage these connections to encourage cessation.

Research Limitations: This is a qualitative, non-generalizable dataset from a fairly limited geographic area.

Public Health Implications: Online smoking cessation interventions aimed at young adults would benefit from further testing with LGB young adults to ensure efficacy among this population. In addition, states and localities concerned about young adult LGB smoking might benefit from investing in an online socially mediated cessation forum. Online interventions could be scalable and might be useful for other groups who regularly face discrimination, stigma, or other stressors that make successful smoking cessation difficult.

Cover of eHealth: Current Evidence, Promises, Perils and Future Directions
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Studies in Media and Communications
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Emerald Publishing Limited
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