Health Information in 2023 (and Beyond): Confronting Emergent Realities With Health Communication Science.

This Viewpoint describes how health communication science can be used to improve response to health challenges by providing credible health information to the public.

Vozes dos criadores e números da criatura: a comunicação das arboviroses no Facebook do Ministério da Saúde do Brasil / Voces de los creadores y números de la criatura: la comunicación de las arbovirosis en el Facebook del Ministerio de Salud de Brasil / Creators' voices and creature's numbers: the communication of arboviruses on Facebook of the Brazilian Ministry of Health

A pesquisa analisa a produção de conteúdos sobre arboviroses na fanpage do Ministério da Saúde do Brasil antes, durante e após a epidemia de Zika vírus, com estudo de métodos mistos englobando análise do conteúdo divulgado entre 2015 e 2017 e o Discurso do Sujeito Coletivo (DSC) dos trabalhadores que produziam os conteúdos. Dos 5.732 posts coletados, 649 deles eram sobre arboviroses, com enfoque maior relacionado à prevenção e à Zika. O Sistema Único de Saúde (SUS) aparece em pequena parte da amostra. Há preocupação em comunicar saúde com qualidade e respaldo técnico, mas diferenças na linguagem do especialista e no timming entre o que é publicado on-line e o repassado aos serviços de saúde ocasionam ruídos. O discurso é transmissional, apresentando ausência de diálogo com a população, subestimando o potencial que a rede social tem para interação, compartilhamento e engajamento.(AU)

La investigación analiza la producción de contenidos sobre arbovirosis en la fanpage del Ministerio de Salud de Brasil antes, durante y después de la epidemia de Zika virus, con estudio de métodos mixtos englobando análisis del contenido divulgado entre 2015 y 2017 y el discurso del sujeto colectivo de los trabajadores que producían los contenidos. De los 5.732 posts colectados, 649 eran sobre arbovirosis, en un enfoque mayor relacionado a la prevención y al Zika. El Sistema Único de Salud aparece en una pequeña parte de la muestra. Existe la preocupación de comunicar salud con calidad y respaldo técnico, pero diferencias en el lenguaje del especialista y en el timing entre lo que se publica online y lo que se traspasa a los servicios de salud causan ruidos. El discurso es de transmisión, con ausencia de diálogo con la población, subestimando el potencial que la red social tiene para la interacción, compartición y compromiso.(AU)

This study analyses the content production about arboviruses on the fan page of the Brazilian Ministry of Health before, during and after the Zika virus epidemic. It uses a mixed methods study that comprises the content analysis released from 2015 to 2017 and the Collective Subject Discourse of the workers who produced the contents. The results show that 649 out of 5,732 posts collected addressed arboviruses, with a greater focus on prevention and Zika. The Brazilian National Health System (SUS) was found in a small part of the sample. There is a concern to inform about health with quality, but differences in the specialist's language and timing between what is published online and what is conveyed to technical health services cause communication noise. It is a transmissional discourse, with no dialogue with the population, underestimating the potential of social media for interaction, sharing and engagement.(AU)

[Public Health Communication Studies in Japan].

Public health communication is an essential component of public health activities to protect and promote the health of all people in all communities. However, research is scarce on how to communicate public health issues effectively to the Japanese population. In this article, I outline the concept of public health communication, present our study findings, and discuss future challenges to developing public health communication programs. More studies are required to establish evidence-based practical guidelines on public health communication in Japan.

Misinformation and public opinion of science and health: Approaches, findings, and future directions.

A summary of the public opinion research on misinformation in the realm of science/health reveals inconsistencies in how the term has been defined and operationalized. A diverse set of methodologies have been employed to study the phenomenon, with virtually all such work identifying misinformation as a cause for concern. While studies completely eliminating misinformation impacts on public opinion are rare, choices around the packaging and delivery of correcting information have shown promise for lessening misinformation effects. Despite a growing number of studies on the topic, there remain many gaps in the literature and opportunities for future studies.

Misinformation in and about science.

Humans learn about the world by collectively acquiring information, filtering it, and sharing what we know. Misinformation undermines this process. The repercussions are extensive. Without reliable and accurate sources of information, we cannot hope to halt climate change, make reasoned democratic decisions, or control a global pandemic. Most analyses of misinformation focus on popular and social media, but the scientific enterprise faces a parallel set of problems-from hype and hyperbole to publication bias and citation misdirection, predatory publishing, and filter bubbles. In this perspective, we highlight these parallels and discuss future research directions and interventions.

The narrative truth about scientific misinformation.

Science and storytelling mean different things when they speak of truth. This difference leads some to blame storytelling for presenting a distorted view of science and contributing to misinformation. Yet others celebrate storytelling as a way to engage audiences and share accurate scientific information. This review disentangles the complexities of how storytelling intersects with scientific misinformation. Storytelling is the act of sharing a narrative, and science and narrative represent two distinct ways of constructing reality. Where science searches for broad patterns that capture general truths about the world, narratives search for connections through human experience that assign meaning and value to reality. I explore how these contrasting conceptions of truth manifest across different contexts to either promote or counter scientific misinformation. I also identify gaps in the literature and identify promising future areas of research. Even with their differences, the underlying purpose of both science and narrative seeks to make sense of the world and find our place within it. While narrative can indeed lead to scientific misinformation, narrative can also help science counter misinformation by providing meaning to reality that incorporates accurate science knowledge into human experience.

(Mis)informed about what? What it means to be a science-literate citizen in a digital world.

Science literacy is often held up as crucial for avoiding science-related misinformation and enabling more informed individual and collective decision-making. But research has not yet examined whether science literacy actually enables this, nor what skills it would need to encompass to do so. In this report, we address three questions to outline what it should mean to be science literate in today's world: 1) How should we conceptualize science literacy? 2) How can we achieve this science literacy? and 3) What can we expect science literacy's most important outcomes to be? If science literacy is to truly enable people to become and stay informed (and avoid being misinformed) on complex science issues, it requires skills that span the "lifecycle" of science information. This includes how the scientific community produces science information, how media repackage and share the information, and how individuals encounter and form opinions on this information. Science literacy, then, is best conceptualized as encompassing three dimensions of literacy spanning the lifecycle: Civic science literacy, digital media science literacy, and cognitive science literacy. Achieving such science literacy, particularly for adults, poses many challenges and will likely require a structural perspective. Digital divides, in particular, are a major structural barrier, and community literacy and building science literacy into media and science communication are promising opportunities. We end with a discussion of what some of the beneficial outcomes could be-and, as importantly, will likely not be-of science literacy that furthers informed and critical engagement with science in democratic society.

Estratégias de comunicação adotadas pela gestão do Sistema Único de Saúde durante a pandemia de Covid-19 - Brasil / Estrategias de comunicación adoptadas por la gestión del Sistema Brasileño de Salud durante la pandemia de Covid-19 - Brasil / Communication strategies adopted by the management of the Brazilian National Health System during the Covid-19 pandemic

Foi realizada caracterização e análise das principais estratégias de comunicação desenvolvidas pelos três níveis de gestão do Sistema Único de Saúde (SUS) para o enfrentamento de Covid-19 no Brasil. Consideraram-se websites, Twitter, Youtube, Instagram e Facebook, coletivas de imprensa, aplicativos e boletins epidemiológicos, totalizando 35 estratégias. Apesar da comunicação ser um dos eixos fundamentais em resposta à pandemia, parte significativa das estratégias não abordou adequadamente as temáticas de vigilância, assistência, promoção e educação em saúde. Observou-se predomínio do modelo de comunicação utilitarista, centralizador e funcional, com foco na transmissão de informações. O Estado tem o dever de promover uma comunicação comunitária e emancipatória, considerando a diversidade de sujeitos, o contexto local e o desenvolvimento de redes comunicativas, respeitando o direito humano e social à comunicação, à informação e à voz, segundo os princípios e diretrizes do SUS. (AU)

Se realizó una caracterización y análisis de las principales estrategias de comunicación desarrolladas por los tres niveles de gestión del Sistema Brasileño de Salud (SUS) para enfrentar la pandemia de Covid-19 en Brasil. Se consideraron páginas web, Twitter, YouTube, Instagram y Facebook, entrevistas colectivas de prensa, aplicaciones y boletines epidemiológicos, totalizando 35 estrategias. Aunque la comunicación es uno de los ejes fundamentales de respuesta a la pandemia, una parte significativa de las estrategias no abordó adecuadamente las temáticas de vigilancias, asistencia, promoción y educación en salud. Se observó el predominio del modelo de comunicación utilitarista, centralizador y funcional, enfocado en la transmisión de informaciones. El Estado tiene el deber de promover una comunicación comunitaria y emancipadora, considerando la diversidad de sujetos, el contexto local y el desarrollo de redes comunicativas, respetando el derecho humano y social a la comunicación, a la información y a la voz, según los principios y directrices del SUS. (AU)

The main communication strategies developed by the three levels of the Brazilian National Health System (SUS) for the management for coping with Covid-19 in Brazil were characterized and analyzed. The research encompassed Websites, Twitter, YouTube, Instagram and Facebook, press conferences, apps and epidemiological bulletins, totaling 35 strategies. Although communication is one of the key axes in response to the pandemic, a significant part of the strategies did not adequately address the topics of surveillance, care, promotion and health education. It was observed a predominance of the utilitarian, centralizing and functional communication model, focusing on the transmission of information. The State has a duty to promote community and emancipatory communication, considering the diversity of subjects, the local context and the development of communicative networks, respecting the human and social right to communication, information and voice, according to the principles and guidelines of the SUS. (AU)

Infodemics and infodemiology: a short history, a long future / Las infodemias y la infodemiología: una historia corta, un largo futuro / Infodemias e infodemiologia: uma breve história, um longo futuro

ABSTRACT An "infodemic" is defined as "an overabundance of information - some accurate and some not - occurring during an epidemic". This paper describes the characteristics of an infodemic, which combines an inordinately high volume of information (leading to problems relating to locating the information, storage capacity, ensuring quality, visibility and validity) and rapid output (making it hard to assess its value, manage the gatekeeping process, apply results, track its history, and leading to a waste of effort). This is bound up with the collateral growth of misinformation, disinformation and malinformation. Solutions to the problems posed by an infodemic will be sought in improved technology and changed social and regulatory frameworks. One solution could be a new trusted top-level domain for health information. The World Health Organization has so far made two unsuccessful attempts to create such a domain, but it is suggested this could be attempted again, in the light of the COVID-19 infodemic experience. The vital role of reliable information in public health should also be explicitly recognized in the Sustainable Development Goals, with explicit targets. All countries should develop knowledge preparedness plans for future emergencies.

RESUMEN Una infodemia se define como 'una sobreabundancia de información —que puede ser correcta o no— durante una epidemia'. En este artículo se describen las características de una infodemia, en la cual se combina un volumen de información desmesuradamente alto (que genera problemas que guardan relación con la búsqueda, la capacidad de almacenamiento, la calidad, la visibilidad y la validez de la información) y la producción acelerada de información (que hace difícil estimar su valor, gestionar el proceso de control, aplicar resultados y rastrear el historial, y además conduce al desperdicio de esfuerzos). Esto está vinculado con el crecimiento colateral de información errónea, la desinformación y la información malintencionada. Se exploran soluciones para los problemas ocasionados por una infodemia mediante tecnologías más avanzadas y cambios en los marcos sociales y regulatorios. Una solución podría ser un dominio de nivel superior nuevo y fidedigno para la información en materia de salud. Hasta el presente, la Organización Mundial de la Salud ha llevado a cabo dos intentos infructuosos de crear dicho dominio, pero se recomienda volver a intentarlo, considerando la experiencia con la infodemia de la COVID-19. Además, el papel clave que desempeña la información fiable en la salud pública debe reconocerse explícitamente en los Objetivos de Desarrollo Sostenible, estableciendo metas explícitas. Todos los países deben elaborar planes de preparación para la gestión del conocimiento con miras a emergencias futuras.

RESUMO Infodemia é definida como "um excesso de informações - algumas exatas e outras não - que ocorre em uma epidemia". Este trabalho descreve as características de uma infodemia, que combina um volume extraordinariamente grande de informação (levando a problemas relacionados à localização, capacidade de armazenamento e garantia da qualidade, visibilidade e validade da informação) com produção acelerada (o que dificulta avaliar seu valor, gerenciar o processo de seleção de informação, aplicar resultados e rastrear seu histórico, resultando em um esforço em vão). Este fenômeno está atrelado ao crescimento colateral de informações falsas, desinformação e desinformação maliciosa. A busca de soluções aos problemas decorrentes de uma infodemia deve estar no aprimoramento da tecnologia e na modificação das estruturas regulatória e social. Uma solução seria criar um domínio de nível superior com credibilidade para informação em saúde. A Organização Mundial da Saúde (OMS) fez até o presente duas tentativas infrutíferas para criar tal domínio. Porém, se recomenda que uma nova tentativa seja feita em vista da experiência adquirida com a infodemia de COVID-19. O papel vital da informação confiável em saúde pública também deve ser expressamente reconhecido nos Objetivos de Desenvolvimento Sustentável, com metas explícitas. Todos os países devem elaborar planos de preparação em conhecimento para futuras emergências.

Improvement for most, but not all: changes in newspaper coverage of mental illness from 2008 to 2019 in England.

AIMS: Time to Change, an anti-stigma programme in England, has worked to reduce stigma relating to mental illness in many facets of life. Newspaper reports are an important factor in shaping public attitudes towards mental illnesses, as well as working as a barometer reflecting public opinion. This study aims to assess the way that coverage of mental health topics and different mental illnesses has changed since 2008. METHOD: Articles covering mental health in 18 different newspapers were retrieved using keyword searches on two randomly chosen days of each month in 2008, 2009, 2010, 2011, 2013, 2014, 2016 and 2019. A content analysis approach using a structured coding framework was used to extract information from the articles. Logistic regression models were used to estimate the change in odds of each hypothesised stigmatising or anti-stigmatising element occurring in 2019 compared to 2008 and 2016 with a Wald test to assess the overall significance of year as a predictor in the model. Further logistic regression models were used to assess the association between the diagnosis that an article was about and the odds that it was stigmatising, and whether this relationship is moderated by year of publication. RESULTS: A total of 6731 articles were analysed, and there was a significant increase in anti-stigmatising articles in 2019 compared to 2008 (OR 3.16 (2.60-3.84), p < 0.001) and 2016 (OR 1.40 (1.16-1.69), p < 0.001). Of the 5142 articles that specified a diagnosis, articles about schizophrenia were 6.37 times more likely to be stigmatising than articles about other diagnoses (OR 6.37 (3.05-13.29) p < 0.001), and there was evidence that the strength of this relationship significantly interacted with the year an article was published (p = 0.010). Articles about depression were significantly less likely to be stigmatising (OR 0.59 (0.69-0.85) p = 0.018) than those about other diagnoses, while there was no difference in coverage of eating disorders v. other diagnoses (OR 1.37 (0.67-2.80) p = 0.386); neither of these relationships showed an interaction with the year of publication. CONCLUSION: Anti-stigma programmes should continue to work with newspapers to improve coverage of mental illness. However, interventions should consider providing specific guidance and promote awareness of rarer mental illnesses, such as schizophrenia, and evaluation should examine whether reductions in stigma extend to people with all mental illness diagnoses.

Enhancing global health communication during a crisis: lessons from the COVID-19 pandemic.

BACKGROUND/OBJECTIVE: The understanding and practice of public health crisis communication are improved through the study of responses to past crises, but require retooling for present challenges. The 'Addressing Ebola and other outbreaks' checklist contains guiding principles built upon maxims developed from a World Health Organization consultation in response to the mad cow (bovine spongiform encephalopathy) crisis that were later adopted for Ebola. The purpose of this article is to adapt the checklist for the health communication challenges and public health practices that have emerged during the coronavirus disease 2019 (COVID-19) pandemic. The communication challenges of promoting vaccine acceptance are used to illustrate a key area that requires strengthened communication. Type of program or service: Effective communication principles for application during the COVID-19 pandemic. RESULTS: The COVID-19 pandemic has introduced unique challenges for public health practitioners and health communicators that warrant an expansion of existing health communication principles to take into consideration: the new infodemic (or mis/disinfodemic) challenge - particularly as treatments and vaccines are being developed; communication of risk and uncertainty; health-information behaviours and the instantaneous nature of social media, and the relationship between media literacy and health literacy; the effects of the pandemic on other health issues; and the need for a flexible communication strategy that adapts to the different stages of the pandemic. LESSONS LEARNT: Principles discussed in this article will help build preparedness capacity and offer communication strategies for moving from the acute phase to the 'next normal' with likely prevention (e.g. herd immunity achieved through vaccination) and societal COVID-19 resilience.

Ten Years of Messaging about the Affordable Care Act in Advertising and News Media: Lessons for Policy and Politics.

Messaging about the Affordable Care Act (ACA) has seemingly produced a variety of outcomes: millions of Americans gained access to health insurance, yet much of the US public remains confused about major components of the law, and there remain stark and persistent political divides in support of the law. Our analysis of the volume and content of ACA-related media (including both ads and news) helps explain these phenomena, with three conclusions. First, the information environment around the ACA has been complex and competitive, with messaging originating from diverse sponsors with multiple objectives. Second, partisan cues in news and political ads are abundant, likely contributing to the crystallized politically polarized opinion about the law. Third, partisan discussions of the ACA in political ads have shifted in volume, direction, and tone over the decade, presenting divergent views regarding which party is accountable for the law's successes (or failures). We offer evidence for each of these conclusions from longitudinal analyses of the volume and content of ACA messaging, also referencing studies that have linked these messages to attitudes and behavior. We conclude with implications for health communication, political science, and the future outlook for health reform.

Temporal and textual analysis of social media on collective discourses during the Zika virus pandemic.

BACKGROUND: While existing studies have investigated the role of social media on health-related communication, little is known about the potential differences between different users groups on different social media platforms in responses to a health event. This study sets out to explore the online discourse of governmental authorities and the public in Singapore during the recent Zika pandemic in 2016. METHODS: Social media data were extracted from Facebook and Twitter using retroactive keyword sourcing of the word "Zika" to search for posts and a location filter of "Singapore". Government posts, public posts, and replies to these original posts were included in the temporal and textual analysis. RESULTS: Overall, Facebook contained more government and individual content whereas Twitter had more content from news media accounts. Though the relative volume of Zika content from different data sources paralleled the peaks and troughs of Zika activities across time, discourses from different data sources differed in their temporal patterns, such that the public discourse died down faster than the government discourse after the outbreak was declared. In addition, the content of discourses differed among data sources. While government discourse included factual information of the disease, public discourse contained more elements of care such as worry about the risks to pregnant women, and elements of community such as well-wishes to each other. CONCLUSIONS: Our study demonstrates the temporal and content differences between user groups and social media platforms in social media conversations during the Zika pandemic. It suggests that future research should examine the collective discourse of a health event by investigating social media discourses within varied sources rather than focusing on a singular social media platform and by one particular type of users.

Entenda a infodemia e a desinformação na luta contra a COVID-19 / Entender la infodemia y la desinformación en la lucha contra la COVID-19 / Understanding the Infodemic and Misinformation in the fight against COVID-19

Conforme declarado pela OMS, o surto de COVID-19 e a resposta a ele têm sido acompanhados por uma enorme infodemia: um excesso de informações, algumas precisas e outras não, que tornam difícil encontrar fontes idôneas e orientações confiáveis quando se precisa. A palavra infodemia se refere a um grande aumento no volume de informações associadas a um assunto específico, que podem se multiplicar exponencialmente em pouco tempo devido a um evento específico, como a pandemia atual. Nessa situação, surgem rumores e desinformação, além da manipulação de informações com intenção duvidosa. Na era da informação, esse fenômeno é amplificado pelas redes sociais e se alastra mais rapidamente, como um vírus.

Según ha declarado la OMS, el brote de COVID-19 y la respuesta correspondiente han estado acompañados de una infodemia masiva, es decir, de una cantidad excesiva de información ‒en algunos casos correcta, en otros no‒ que dificulta que las personas encuentren fuentes confiables y orientación fidedigna cuando las necesitan. El término infodemia se refiere a un gran aumento del volumen de información relacionada con un tema particular, que puede volverse exponencial en un período corto debido a un incidente concreto como la pandemia actual. En esta situación aparecen en escena la desinformación y los rumores, junto con la manipulación de la información con intenciones dudosas. En la era de la información, este fenómeno se amplifica mediante las redes sociales, propagándose más lejos y más rápido, como un virus.

What is the Infodemic? As stated by the WHO, the COVID-19 outbreak and response has been accompanied by a massive infodemic: an overabundance of information ­ some accurate and some not ­ that makes it hard for people to find trustworthy sources and reliable guidance when they need it. Infodemic refers to a large increase in the volume of information associated with a specific topic and whose growth can occur exponentially in a short period of time due to a specific incident, such as the current pandemic. In this situation, misinformation and rumors appear on the scene, along with manipulation of information with doubtful intent. In the information age, this phenomenon is amplified through social networks, spreading farther and faster like a virus.

Quer tirar dúvidas sobre o coronavírus? O Ministério da Saúde responde

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Why Most of Your Patients Aren't Using an Online Portal, and What You Can Do About It.

Online portals that provide patients with secure access to their medical records and provider communication can improve health care. Yet new technologies can also exacerbate existing health disparities. We analyzed information about 2,325 insured respondents to the nationally representative 2017 Health Information National Trends Survey to examine characteristics of portal nonusers and reasons for nonuse. Sixty-three percent reported not using a portal during the prior year. In multivariable analysis, we found that nonusers were more likely to be male, be on Medicaid, lack a regular provider, and have less than a college education, compared to users. Similar disparities existed in who reported being offered access to a portal, with nonwhites also less likely to report being offered access. Reasons for nonuse included privacy concerns and the desire to speak directly to providers, both of which indicate the important role of the doctor-patient relationship.

Effectiveness of email-based reminders to increase vaccine uptake: a systematic review.

BACKGROUND: In times of vaccine hesitancy and decreasing immunization coverage, it is crucial to exploit the potential of digital solutions to support immunization programmes and ultimately increase vaccine uptake. Scant evidence exists on the impact of email-based immunization reminders. In particular, while email communication is exponentially increasing at the global level, its use for health communication is still sporadic and limited data exists on its application to immunization programmes. The objective of this study is to systematically retrieve and critically appraise the available literature on the effectiveness of email-based reminders to increase vaccine uptake, with the ultimate aim to inform and encourage its integration in the implementation of immunization programmes. METHODS: We conducted a systematic review of literature following the PRISMA. We included studies providing quantitative comparative data on any measure of vaccine uptake. We extracted data on study design, study population, vaccine type and details of email-based interventions; data were pooled by type of comparison (no reminders, traditional reminders, other digital reminders). RESULTS: Eleven studies were included, 90% with experimental study designs. While email communication succeeds in increasing vaccine uptake when compared with no intervention, weak and heterogeneous data exist supporting the superiority of email reminders, as compared to traditional methods or other digital reminders. Encouraging evidence report the effectiveness of reminder methods combining different strategies and tailored to target populations' preferences. CONCLUSIONS: Theoretically, email communication offers many advantages: it is cheaper and faster, it can be automated and linked to electronic immunization registries, and reach people on the move. As we urge the need for further research to prove email communication impact on vaccine uptake in different settings, we underline the importance of identifying how to best integrate email communication in vaccine delivery equipping immunization programmes with technical infrastructures and normative frameworks suitable to embrace innovation.

Changes in internet use and wishes of cancer survivors: A comparison between 2005 and 2017.

BACKGROUND: Given the major changes in internet use for health communication, the objective of the current study was to compare the internet use and wishes of cancer survivors between 2005 and 2017. METHODS: The authors drew a sample of 390 patients in 2005 and 539 patients in 2017 who were diagnosed with breast (128 patients in 2005 and 143 patients in 2017), prostate (96 patients in 2005 and 126 patients in 2017), or gynecologic (89 patients in 2005 and 188 patients in 2017) cancer or lymphoma (77 patients in 2005 and 82 patients in 2017) in 4 different hospitals for the periods 2002 through 2004 and 2014 through 2016. These patients were sent a paper-based questionnaire that contained 45 questions regarding demographics and 4 functions of internet use: content, communication, community, and e-health. RESULTS: The response in 2017 (53%) was lower than that in 2005 (75%). Survivors browsed the internet most frequently to search for information regarding cancer shortly after being diagnosed and while waiting for treatment. There was little change noted with regard to the relative importance attached to the various subjects. In 2017, significant increases were evident with regard to finances (+33%), health care insurance (+29%), and genetics and/or heritability (+27%). The wishes expressed in 2005 by patients were realized in part in 2017. CONCLUSIONS: A significant sample of cancer survivors in the Netherlands have indicated that the internet is an important source of information regarding their illness. However, little change was evident over the past 15 years with regard to patients' priorities regarding their wishes for internet use. The wishes of users in 2005 were found to accurately reflect the internet use of the majority of patients in 2017. The results of the current study support the belief that health care professionals should expand their online services and tailor them toward the needs and wishes of their patients.