COVID-19 increased censorship circumvention and access to sensitive topics in China.

Crisis motivates people to track news closely, and this increased engagement can expose individuals to politically sensitive information unrelated to the initial crisis. We use the case of the COVID-19 outbreak in China to examine how crisis affects information seeking in countries that normally exert significant control over access to media. The crisis spurred censorship circumvention and access to international news and political content on websites blocked in China. Once individuals circumvented censorship, they not only received more information about the crisis itself but also accessed unrelated information that the regime has long censored. Using comparisons to democratic and other authoritarian countries also affected by early outbreaks, the findings suggest that people blocked from accessing information most of the time might disproportionately and collectively access that long-hidden information during a crisis. Evaluations resulting from this access, negative or positive for a government, might draw on both current events and censored history.

Rational inattention: A new theory of neurodivergent information seeking.

This paper presents rational inattention as a new, transdiagnostic theory of information seeking in neurodevelopmental conditions that have uneven cognitive and socio-emotional profiles, including developmental language disorder (DLD), dyslexia, dyscalculia and autism. Rational inattention holds that the optimal solution to minimizing epistemic uncertainty is to avoid imprecise information sources. The key theoretical contribution of this report is to endogenize imprecision, making it a function of the primary neurocognitive difficulties that have been invoked to explain neurodivergent phenotypes, including deficits in auditory perception, working memory, procedural learning and the social brain network. We argue that disengagement with information sources with low endogenous precision (e.g. speech in DLD, orthography-phonology mappings in dyslexia, numeric stimuli in dyscalculia and social signals in autism) constitutes resource-rational behaviour. We demonstrate the strength of this account in a series of computational simulations. In experiment 1, we simulate information seeking in artificial agents mimicking an array of neurodivergent phenotypes, which optimally explore a complex learning environment containing speech, text, numeric stimuli and social cues. In experiment 2, we simulate optimal information seeking in a cross-modal dual-task paradigm and qualitatively replicate empirical data from children with and without DLD. Across experiments, simulated agents' only aim was to maximally reduce epistemic uncertainty, with no difference in reward across information sources. We show that rational inattention emerges naturally in specific neurodivergent phenotypes as a function of low endogenous precision. For instance, an agent mimicking the DLD phenotype disengages with speech (and preferentially engages with alternative precise information sources) because endogenous imprecision renders speech not conducive to information gain. Because engagement is necessary for learning, simulation demonstrates how optimal information seeking may paradoxically contribute negatively to an already delayed learning trajectory in neurodivergent children. RESEARCH HIGHLIGHTS: We present the first comprehensive theory of information seeking in neurodivergent children to date, centred on the notion of rational inattention. We demonstrate the strength of this account in a series of computational simulations involving artificial agents mimicking specific neurodivergent phenotypes that optimally explore a complex learning environment containing speech, text, numeric stimuli, and social cues. We show how optimal information seeking may, paradoxically, contribute negatively to an already delayed learning trajectory in neurodivergent children. This report advances our understanding of the factors shaping short-term decision making and long-term learning in neurodivergent children.

The effect of noninstrumental information on reward learning.

Investigations of information-seeking often highlight people's tendency to forgo financial reward in return for advance information about future outcomes. Most of these experiments use tasks in which reward contingencies are described to participants. The use of such descriptions leaves open the question of whether the opportunity to obtain such noninstrumental information influences people's ability to learn and represent the underlying reward structure of an experimental environment. In two experiments, participants completed a two-armed bandit task with monetary incentives where reward contingencies were learned via trial-by-trial experience. We find, akin to description-based tasks, that participants are willing to forgo financial reward to receive information about a delayed, unchangeable outcome. Crucially, however, there is little evidence this willingness to pay for information is driven by an inaccurate representation of the reward structure: participants' representations approximated the underlying reward structure regardless of the presence of advance noninstrumental information. The results extend previous conclusions regarding the intrinsic value of information to an experience-based domain and highlight challenges of probing participants' memories for experienced rewards.

Question-asking as a mechanism of information seeking.

Ivancovsky et al. explore the relationship between curiosity and creativity, by suggesting they align through novelty-seeking mechanisms. We argue that a general mechanism linking both capacities together is question-asking: Curiosity drives question-asking that leads to creative problem solving. Yet, current findings from our lab suggest that question complexity relates to creativity, but not necessarily to curiosity, warranting further investigation.

Common neural code for reward and information value.

Adaptive information seeking is critical for goal-directed behavior. Growing evidence suggests the importance of intrinsic motives such as curiosity or need for novelty, mediated through dopaminergic valuation systems, in driving information-seeking behavior. However, valuing information for its own sake can be highly suboptimal when agents need to evaluate instrumental benefit of information in a forward-looking manner. Here we show that information-seeking behavior in humans is driven by subjective value that is shaped by both instrumental and noninstrumental motives, and that this subjective value of information (SVOI) shares a common neural code with more basic reward value. Specifically, using a task where subjects could purchase information to reduce uncertainty about outcomes of a monetary lottery, we found information purchase decisions could be captured by a computational model of SVOI incorporating utility of anticipation, a form of noninstrumental motive for information seeking, in addition to instrumental benefits. Neurally, trial-by-trial variation in SVOI was correlated with activity in striatum and ventromedial prefrontal cortex. Furthermore, cross-categorical decoding revealed that, within these regions, SVOI and expected utility of lotteries were represented using a common code. These findings provide support for the common currency hypothesis and shed insight on neurocognitive mechanisms underlying information-seeking behavior.

Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study.

BACKGROUND: In recent years, medical journals have emphasized the increasingly critical role that social media plays in the dissemination of public health information and disease prevention guidelines. However, platforms such as Facebook and Twitter continue to pose unique challenges for clinical health care providers and public health officials alike. In order to effectively communicate during public health emergencies, such as the COVID-19 pandemic, it is increasingly critical for health care providers and public health officials to understand how patients gather health-related information on the internet and adjudicate the merits of such information. OBJECTIVE: With that goal in mind, we conducted a survey of 1003 US-based adults to better understand how health consumers have used social media to learn and stay informed about the COVID-19 pandemic, the extent to which they have relied on credible scientific information sources, and how they have gone about fact-checking pandemic-related information. METHODS: A web-based survey was conducted with a sample that was purchased through an industry-leading market research provider. The results were reported with a 95% confidence level and a margin of error of 3. Participants included 1003 US-based adults (aged ≥18 years). Participants were selected via a stratified quota sampling approach to ensure that the sample was representative of the US population. Balanced quotas were determined (by region of the country) for gender, age, race, and ethnicity. RESULTS: The results showed a heavy reliance on social media during the COVID-19 pandemic; more than three-quarters of respondents (762/1003, 76%) reported that they have relied on social media at least "a little," and 59.2% (594/1003) of respondents indicated that they read information about COVID-19 on social media at least once per week. According to the findings, most social media users (638/1003, 63.6%) were unlikely to fact-check what they see on the internet with a health professional, despite the high levels of mistrust in the accuracy of COVID-19-related information on social media. We also found a greater likelihood of undergoing vaccination among those following more credible scientific sources on social media during the pandemic (χ216=50.790; φ=0.258; P<.001). CONCLUSIONS: The findings suggest that health professionals will need to be both strategic and proactive when engaging with health consumers on social media if they hope to counteract the deleterious effects of misinformation and disinformation. Effective training, institutional support, and proactive collaboration can help health professionals adapt to the evolving patterns of health information seeking.

COVID-19 Information-Seeking and Prevention Behaviors in Florida, April 2020.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) surveillance can be enhanced by collecting population-level data on individual prevention measures. We described the use of a state-based, population-level surveillance system on COVID-19 prevention and information-seeking behaviors in Florida during the first month of survey administration. METHODS: Beginning in April 2020, respondents of the Florida Behavioral Risk Factor Surveillance System were asked a series of 8 questions about sources of COVID-19 information and prevention behaviors. We analyzed the prevalence of information-seeking and prevention behaviors among respondents who answered at least 1 of the 8 questions (N = 1,004) overall, by demographic characteristics, and by the presence of chronic conditions. RESULTS: Most respondents reported engaging in prevention behaviors, including handwashing (98.2%), reducing or avoiding travel (96.6%), avoiding crowds and public events (96.5%), and keeping household members at home (87.5%); however, the prevalence of prevention behaviors varied significantly by age, sex, and education. The most frequently reported source of COVID-19 information was the Centers for Disease Control and Prevention's website (40.8%) followed by the Florida Department of Health's website (32.9%). We found significant differences in information sources across all demographic and chronic condition subgroups. A larger proportion of respondents with chronic conditions (vs without chronic conditions) reported consulting their personal doctor for COVID-19 information. CONCLUSION: Understanding the uptake and characteristics associated with individual prevention and information-seeking behaviors at the population level facilitates COVID-19 response efforts. The rapid implementation of COVID-19-related questions in the Florida BRFSS provides a useful model for other population-based surveillance systems.

Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study.

BACKGROUND: Digital communication technologies are playing an important role in the health communication strategies of governments and public health authorities during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and on protective behaviors. In addition, the COVID-19 infodemic is spreading faster than the coronavirus itself, which interferes with governmental health-related communication efforts. This jeopardizes national public health containment strategies. Therefore, digital health literacy is a key competence to navigate web-based COVID-19-related information and service environments. OBJECTIVE: This study aimed to investigate university students' digital health literacy and web-based information-seeking behaviors during the early stages of the COVID-19 pandemic in Germany. METHODS: A cross-sectional study among 14,916 university students aged ≥18 years from 130 universities across all 16 federal states of Germany was conducted using a web-based survey. Along with sociodemographic characteristics (sex, age, subjective social status), the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Web-based information-seeking behavior was investigated by examining the web-based sources used by university students and the topics that the students searched for in connection with COVID-19. Data were analyzed using univariate and bivariate analyses. RESULTS: Across digital health literacy dimensions, the greatest difficulties could be found for assessing the reliability of health-related information (5964/14,103, 42.3%) and the ability to determine whether the information was written with a commercial interest (5489/14,097, 38.9%). Moreover, the respondents indicated that they most frequently have problems finding the information they are looking for (4282/14,098, 30.4%). When stratified according to sociodemographic characteristics, significant differences were found, with female university students reporting a lower DHLI for the dimensions of "information searching" and "evaluating reliability." Search engines, news portals, and websites of public bodies were most often used by the respondents as sources to search for information on COVID-19 and related issues. Female students were found to use social media and health portals more frequently, while male students used Wikipedia and other web-based encyclopedias as well as YouTube more often. The use of social media was associated with a low ability to critically evaluate information, while the opposite was observed for the use of public websites. CONCLUSIONS: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key.

Children's Social Information Seeking is Sensitive to Referential Ambiguity.

We examined children's spontaneous information seeking in response to referential ambiguity. Children ages 2-5 (n = 160) identified the referents of familiar and novel labels. We manipulated ambiguity by changing the number of objects present and their familiarity (Experiments 1 and 2), and the availability of referential gaze (Experiment 2). In both experiments, children looked to the face of the experimenter more often while responding, specifically when the referent was ambiguous. In Experiment 2, 3- to 4-year olds also demonstrated sensitivity to graded referential evidence. These results suggest that social information seeking is an active learning behavior that could contribute to language acquisition in early childhood.

Information socialtaxis and efficient collective behavior emerging in groups of information-seeking agents.

Individual behavior, in biology, economics, and computer science, is often described in terms of balancing exploration and exploitation. Foraging has been a canonical setting for studying reward seeking and information gathering, from bacteria to humans, mostly focusing on individual behavior. Inspired by the gradient-climbing nature of chemotaxis, the infotaxis algorithm showed that locally maximizing the expected information gain leads to efficient and ethological individual foraging. In nature, as well as in theoretical settings, conspecifics can be a valuable source of information about the environment. Whereas the nature and role of interactions between animals have been studied extensively, the design principles of information processing in such groups are mostly unknown. We present an algorithm for group foraging, which we term "socialtaxis," that unifies infotaxis and social interactions, where each individual in the group simultaneously maximizes its own sensory information and a social information term. Surprisingly, we show that when individuals aim to increase their information diversity, efficient collective behavior emerges in groups of opportunistic agents, which is comparable to the optimal group behavior. Importantly, we show the high efficiency of biologically plausible socialtaxis settings, where agents share little or no information and rely on simple computations to infer information from the behavior of their conspecifics. Moreover, socialtaxis does not require parameter tuning and is highly robust to sensory and behavioral noise. We use socialtaxis to predict distinct optimal couplings in groups of selfish vs. altruistic agents, reflecting how it can be naturally extended to study social dynamics and collective computation in general settings.

The Online Health Information Needs of Family Physicians: Systematic Review of Qualitative and Quantitative Studies.

BACKGROUND: Digitalization and the increasing availability of online information have changed the way in which information is searched for and retrieved by the public and by health professionals. The technical developments in the last two decades have transformed the methods of information retrieval. Although systematic evidence exists on the general information needs of specialists, and in particular, family physicians (FPs), there have been no recent systematic reviews to specifically address the needs of FPs and any barriers that may exist to accessing online health information. OBJECTIVE: This review aims to provide an up-to-date perspective on the needs of FPs in searching, retrieving, and using online information. METHODS: This systematic review of qualitative and quantitative studies searched a multitude of databases spanning the years 2000 to 2020 (search date January 2020). Studies that analyzed the online information needs of FPs, any barriers to the accessibility of information, and their information-seeking behaviors were included. Two researchers independently scrutinized titles and abstracts, analyzing full-text papers for their eligibility, the studies therein, and the data obtained from them. RESULTS: The initial search yielded 4541 studies for initial title and abstract screening. Of the 144 studies that were found to be eligible for full-text screening, 41 were finally included. A total of 20 themes were developed and summarized into 5 main categories: individual needs of FPs before the search; access needs, including factors that would facilitate or hinder information retrieval; quality needs of the information to hand; utilization needs of the information available; and implication needs for everyday practice. CONCLUSIONS: This review suggests that searching, accessing, and using online information, as well as any pre-existing needs, barriers, or demands, should not be perceived as separate entities but rather be regarded as a sequential process. Apart from accessing information and evaluating its quality, FPs expressed concerns regarding the applicability of this information to their everyday practice and its subsequent relevance to patient care. Future online information resources should cater to the needs of the primary care setting and seek to address the way in which such resources may be adapted to these specific requirements.

Using Social Media Data to Understand Consumers' Information Needs and Emotions Regarding Cancer: Ontology-Based Data Analysis Study.

BACKGROUND: Analysis of posts on social media is effective in investigating health information needs for disease management and identifying people's emotional status related to disease. An ontology is needed for semantic analysis of social media data. OBJECTIVE: This study was performed to develop a cancer ontology with terminology containing consumer terms and to analyze social media data to identify health information needs and emotions related to cancer. METHODS: A cancer ontology was developed using social media data, collected with a crawler, from online communities and blogs between January 1, 2014 and June 30, 2017 in South Korea. The relative frequencies of posts containing ontology concepts were counted and compared by cancer type. RESULTS: The ontology had 9 superclasses, 213 class concepts, and 4061 synonyms. Ontology-driven natural language processing was performed on the text from 754,744 cancer-related posts. Colon, breast, stomach, cervical, lung, liver, pancreatic, and prostate cancer; brain tumors; and leukemia appeared most in these posts. At the superclass level, risk factor was the most frequent, followed by emotions, symptoms, treatments, and dealing with cancer. CONCLUSIONS: Information needs and emotions differed according to cancer type. The observations of this study could be used to provide tailored information to consumers according to cancer type and care process. Attention should be paid to provision of cancer-related information to not only patients but also their families and the general public seeking information on cancer.

Lifestyle Segmentation to Explain the Online Health Information-Seeking Behavior of Older Adults: Representative Telephone Survey.

BACKGROUND: As a result of demographic changes, the number of people aged 60 years and older has been increasing steadily. Therefore, older adults have become more important as a target group for health communication efforts. Various studies show that online health information sources have gained importance among younger adults, but we know little about the health-related internet use of senior citizens in general and in particular about the variables explaining their online health-related information-seeking behavior. Media use studies indicate that in addition to sociodemographic variables, lifestyle factors might play a role in this context. OBJECTIVE: The aim of this study was to examine older people's health-related internet use. Our study focused on the explanatory potential of lifestyle types over and above sociodemographic variables to predict older adults' internet use for health information. METHODS: A telephone survey was conducted with a random sample of German adults aged 60 years and older (n=701) that was quota-allocated by gender, age, educational status, and degree of urbanity of their place of residence. RESULTS: The results revealed that participants used the internet infrequently (mean 1.82 [SD 1.07]), and medical personnel (mean 2.89 [SD 1.11]), family and friends (mean 2.86 [SD 1.21]), and health brochures (mean 2.85 [SD 1.21]) were their main sources of health information. A hierarchical cluster analysis based on values, interests, and leisure time activities revealed three different lifestyle types for adults aged over 60 years: the Sociable Adventurer, the Average Family Person, and the Uninterested Inactive. After adding these types as second-step predictors in a hierarchical regression model with sociodemographic variables (step 1), the explained variance increased significantly (R2=.02, P=.001), indicating that the Average Family Person and the Sociable Adventurer use the internet more often for health information than the Uninterested Inactive, over and above their sociodemographic attributes. CONCLUSIONS: Our findings indicate that the internet still plays only a minor role in the health information-seeking behavior of older German adults. Nevertheless, there are subgroups including younger, more active, down-to-earth and family-oriented males that may be reached with online health information. Our findings suggest that lifestyle types should be taken into account when predicting health-related internet use behavior.

Online Health Information Seeking by Parents for Their Children: Systematic Review and Agenda for Further Research.

BACKGROUND: Parents commonly use the internet to search for information about their child's health-related symptoms and guide parental health-related decisions. Despite the impact of parental online health seeking on offline health behaviors, this area of research remains understudied. Previous literature has not adequately distinguished searched behaviors when searching for oneself or one`s child. OBJECTIVE: The purpose of this review is to examine prevalences and associated variables of parent-child online health information seeking; investigate parents' health-related online behavior regarding how they find, use, and evaluate information; and identify barriers and concerns that they experience during the search. Based on this analysis, we develop a conceptual model of potentially important variables of proxy online health information seeking, with a focus on building an agenda for further research. METHODS: We conducted a comprehensive systematic literature review of the PsycINFO, JMIR, and PubMed electronic databases. Studies between January 1994 and June 2018 were considered. The conceptual model was developed using an inductive mixed methods approach based on the investigated variables in the study sample. RESULTS: A total of 33 studies met the inclusion criteria. Findings suggest that parents worldwide are heavy online users of health-related information for their children across highly diverse circumstances. A total of 6 studies found high parental health anxiety, with prevalences ranging from 14% to 52%. Although parents reported wishing for more guidance from their pediatrician on how to find reliable information, they rarely discussed retrieved information from the web. The conceptual model of proxy online health information seeking includes 49 variables. CONCLUSIONS: This systematic review identifies important gaps regarding the influence of health-related information on parents' health behavior and outcomes. Follow-up studies are required to offer parents guidance on how to use the web for health purposes in an effective way, as well as solutions to the multifaceted problems during or after online health information seeking for their child. The conceptual model with the number of studies in each model category listed highlights how previous studies have hardly considered relational variables between the parent and child. An agenda for future research is presented.

The Impact of Portal Satisfaction on Portal Use and Health-Seeking Behavior: Structural Equation Analysis.

BACKGROUND: Our study addresses a gap in the modern information systems (IS) use literature by investigating factors that explain patient portal satisfaction (SWP) and perceptions about health-seeking behavior (HSB). A novel feature of our study is the incorporation of actual portal use data rather than the perceptions of use intention, which prevails in the modern IS literature. OBJECTIVE: This study aimed to empirically validate factors that influence SWP as an influencing agent on portal use and HSB. Our population segment was comprised of college students with active patient portal accounts. METHODS: Using web-based survey data from a population of portal users (n=1142) in a university health center, we proposed a theoretical model that adapts constructs from the Technology Acceptance Model by Davis, the revised Technology Adoption Model by Venkatesh, the Unified Theory of the Acceptance and Use of Technology 2, and the Health Belief Model by Rosenstock et al. We validated our model using structural equation modeling techniques. RESULTS: Our model explained nearly 65% of the variance in SWP (R2=0.6499), nearly 33% of the variance in portal use (R2=0.3250), and 29% of the variance in HSB (R2=0.2900). Statistically significant antecedents of SWP included social influence (beta=.160, t499=6.145), habit (beta=.114, t499=4.89), facilitating conditions (beta=.062, t499=2.401), effort expectancy (beta=.311, t499=11.149), and performance expectancy (beta=.359, t499=11.588). SWP influenced HSB (beta=.505, t499=19.705) and portal use (beta=.050, t499=2.031). We did not find a statistically significant association between portal use and HSB (beta=.015, t499=0.513). Perceived severity significantly influenced HSB (beta=.129, t499=4.675) but not portal use (beta=.012, t499=.488). CONCLUSIONS: Understanding the importance of SWP and the role it plays in influencing HSB may point to future technology design considerations for information technology developers and health care providers. We extend current Expectancy Confirmation Theory research by finding a positive association between SWP and portal use.

The Use of Technology for Communicating With Clinicians or Seeking Health Information in a Multilingual Urban Cohort: Cross-Sectional Survey.

BACKGROUND: Technology is being increasingly used to communicate health information, but there is limited knowledge on whether these strategies are effective for vulnerable populations, including non-English speaking or low-income individuals. OBJECTIVE: This study assessed how language preferences (eg, English, Spanish, or Chinese), smartphone ownership, and the type of clinic for usual source of care (eg, no usual source of care, nonintegrated safety net, integrated safety net, private or community clinic, academic tertiary medical center, or integrated payer-provider) affect technology use for health-related communication. METHODS: From May to September 2017, we administered a nonrandom, targeted survey to 1027 English-, Spanish-, and Chinese-speaking San Francisco residents and used weighted multivariable logistic regression analyses to assess predictors of five technology use outcomes. The three primary predictors of interest-language preference, smartphone ownership, and type of clinic for usual care-were adjusted for age, gender, race or ethnicity, limited English proficiency, educational attainment, health literacy, and health status. Three outcomes focused on use of email, SMS text message, or phone apps to communicate with clinicians. The two other outcomes were use of Web-based health videos or online health support groups. RESULTS: Nearly one-third of participants watched Web-based health videos (367/1027, 35.74%) or used emails to communicate with their clinician (318/1027, 30.96%). In adjusted analyses, individuals without smartphones had significantly lower odds of texting their clinician (adjusted odds ratio [aOR] 0.27, 95% CI 0.13-0.56), using online health support groups (aOR 0.14, 95% CI 0.04-0.55), or watching Web-based health videos (aOR 0.31, 95% CI 0.15-0.64). Relative to English-speaking survey respondents, individuals who preferred Chinese had lower odds of texting their clinician (aOR 0.25, 95% CI 0.08-0.79), whereas Spanish-speaking survey respondents had lower odds of using apps to communicate with clinicians (aOR 0.34, 95% CI 0.16-0.75) or joining an online support group (aOR 0.30, 95% CI 0.10-0.92). Respondents who received care from a clinic affiliated with the integrated safety net, academic tertiary medical center, or integrated payer-provider systems had higher odds than individuals without a usual source of care at using emails, SMS text messages, or apps to communicate with clinicians. CONCLUSIONS: In vulnerable populations, smartphone ownership increases the use of many forms of technology for health purposes, but device ownership itself is not sufficient to increase the use of all technologies for communicating with clinicians. Language preference impacts the use of technology for health purposes even after considering English proficiency. Health system factors impact patients' use of technology-enabled approaches for communicating with clinicians. No single factor was associated with higher odds of using technology for all health purposes; therefore, existing disparities in the use of digital health tools among diverse and vulnerable populations can only be addressed using a multipronged approach.

Web-Based Medical Information Searching by Chinese Patients With Breast Cancer and its Influence on Survival: Observational Study.

BACKGROUND: The internet allows patients to easily look for health information. However, how Chinese patients with breast cancer use the internet has rarely been investigated, and there is a scarcity of information about the influence of internet use on survival. OBJECTIVE: This observational study aimed to investigate the details of online medical information searching by Chinese patients with breast cancer and to determine whether internet use has any survival benefits. METHODS: Patients who were diagnosed with invasive breast cancer at Peking Union Medical College Hospital between January 2014 and December 2015 were enrolled. We obtained information on their internet-searching behavior and gathered data from the patients' medical and follow-up records. The associations between internet use and other clinic-pathological factors were analyzed. A Cox proportional-hazards model and the Kaplan-Meier method were used for disease-free survival (DFS) analyses. RESULTS: A total of 973 patients with invasive breast cancer who underwent definitive surgery took part in the study. Among them, 477 cases (49.0%) performed web-based breast cancer information searching before the initial treatment. A multivariate logistic regression analysis suggested that web-based breast cancer information searching was significantly associated with younger age (odds ratio [OR] 0.95, 95% CI 0.94-0.97, P<.001), higher education level (OR 1.37, 95% CI 1.01-1.86, P=.04), and breast conserving surgery (OR 1.35, 95% CI 1.04-1.77, P=.03). Baidu (73.4%, 350/477) and WeChat (66.7%, 318/477) were the two most popular online information sources for breast cancer; however, only 44.9% (214/477) felt satisfied with the online information. In contrast to the nonweb searching group, the web-using patients who were satisfied with online information showed significantly improved DFS (hazard ratio 0.26; 95% CI 0.08-0.88, P=.03). CONCLUSIONS: The patients who were most likely to search the internet for breast cancer information were younger and well-educated, and they were more likely to have breast conserving therapy. Web-using patients who were satisfied with the internet information showed significantly improved DFS. Patients should browse credible websites offering accurate and updated information, and website developers should provide high-quality and easy-to-understand information to better meet the needs of patients with breast cancer.

The Association Between Health Information Seeking on the Internet and Physician Visits (The Seventh Tromsø Study - Part 4): Population-Based Questionnaire Study.

BACKGROUND: The internet is being widely used for seeking health information. However, there is no consensus on the association between health information seeking on the internet and the use of health care services. OBJECTIVE: We examined the association between health information seeking via the internet and physician visits. In addition, we investigated the association between online health information seeking and the decisions to visit and not to visit a physician. METHODS: We used the cross-sectional electronic health (eHealth) data of 18,197 participants from the seventh survey of the Tromsø Study (Tromsø 7). The participants were aged ≥40 years and living in Tromsø, Norway. We used logistic regression models to examine the association between online health information seeking and physician visits, the decision to visit a physician, and the decision not to visit a physician, with adjustment for the demographic status, socioeconomic status, and health status of the participants. RESULTS: The use of Web search engines was associated with a physician visit. However, the association was moderated by age, and the OR decreased as age increased. The ORs for the use of Web search engines were 1.99 (95% CI 1.94-2.02) and 1.07 (95% CI 1.03-1.12) at ages 40 and 80 years, respectively. The decision to visit a physician was associated with the use of Web search engines (OR 2.95, 95% CI 2.03-4.46), video search engines (OR 1.43, 95% CI 1.21-1.70), and health apps (OR 1.26, 95% CI 1.13-1.42). The association between social media use and the decision to visit a physician was moderated by gender. Women who used social media had 1.42 (95% CI 1.31-1.55) times higher odds of deciding to visit a physician, whereas the decision to visit a physician was not different between men who used social media and those who did not use social media. Conversely, the decision not to visit a physician was associated with the use of Web search engines (OR 2.78, 95% CI 1.92-4.18), video search engines (OR 1.27, 95% CI 1.07-1.51), social media (OR 1.28, 95% CI 1.10-1.49), and health apps (OR 1.20, 95% CI 1.07-1.35). CONCLUSIONS: Health information found on the internet was positively associated with both the decision to visit a physician and the decision not to visit a physician. However, the association of health information seeking with the decision to visit a physician was slightly stronger than the association with the decision not to visit a physician. This could imply that the use of eHealth services is associated with a resultant increase in physician visits. In summary, our findings suggest that the internet serves as a supplement to health care services rather than as a replacement.

Internet-Based Health Information-Seeking Behavior of Students Aged 12 to 14 Years: Mixed Methods Study.

BACKGROUND: Many children and adolescents are surrounded by smartphones, tablets, and computers and know how to search the internet for almost any information. However, very few of them know how to select proper information from reliable sources. This can become a problem when health issues are concerned, where it is vital to identify incorrect or misleading information. The competence to critically evaluate digital information on health issues is of increasing importance for adolescents. OBJECTIVE: The aim of this study was to assess how children and adolescents rate their internet-based health literacy and how their actual literacy differs from their ratings. In addition, there was a question on how their search performance is related to their self-efficacy. To evaluate these questions, a criteria-based analysis of the quality of the websites they visited was performed. Finally, the possibility to increase their internet-based health literacy in a 3-day workshop was explored. METHODS: A workshop with a focus on health literacy was attended by 14 children and adolescents in an Austrian secondary school. After prior assessments (Culture Fair Intelligence Test, revised German version; Reading Speed and Reading Comprehension Test for Grades 6 to 12, German; electronic health literacy scale [eHEALS]; and General Self-Efficacy Scale, Reversed Version, German), the students were asked to perform an internet-based search on a health-related issue. Browser histories and screenshots of all internet searches were gathered, clustered, and analyzed. After the workshop, the health literacy of the students was assessed again by using the eHEALS. RESULTS: The 14 students opened a total of 85 homepages, but only eight of these homepages were rated as good or fair by two experts (independent rating) based on specific criteria. The analysis showed that the students judged their own internet-based health literacy much higher than the actual value, and students who had rated themselves better did not visit websites of high quality. Internet-based health literacy correlated significantly with the self-efficacy of the students (rs=0.794, P=.002). CONCLUSIONS: Our study showed that it is possible to draw the attention of students to critical aspects of internet search and to slightly improve their search competence in a workshop. Targeted improvement of health literacy is urgently required, and students need special instruction for this purpose. Further investigations in this area with larger sets of data, which could be feasible with the help of a computer program, are urgently needed.

Patients' Convergence of Mass and Interpersonal Communication on an Online Forum: Hybrid Methods Analysis.

BACKGROUND: Patients are increasingly taking an active role in their health. In doing so, they combine both mass and interpersonal media to gratify their cognitive and affective needs (ie, convergence). Owing to methodological challenges when studying convergence, a detailed view of how patients are using different types of media for needs fulfillment is lacking. OBJECTIVE: The aim of this study was to obtain insight into the frequency of reported convergence, how convergence affects what posters write online, motives for posting, and the needs posters are trying to fulfill. METHODS: Using a hybrid method of content analysis and supervised machine learning, this study used naturally available data to fill this research gap. We analyzed opening posts (N=1708) of an online forum targeting cancer patients and their relatives (Kanker.nl). RESULTS: Nearly one-third of the forum opening posts contained signs of convergence in mass or interpersonal media. Posts containing mass media references disclosed less personal information and were more geared toward community enhancement and sharing experiences compared to posts without convergence. Furthermore, compared to posts without signs of convergence, posts that included interpersonal media references disclosed more personal information, and posters were more likely to ask for the experiences of fellow users to fulfill their needs. Within posts containing signs of convergence, posts including interpersonal media references reported fewer shortages of information, disclosed more information about the disease, and were more active in seeking other posters' experiences compared to posts containing mass media references. CONCLUSIONS: The current study highlights the intertwining of media platforms for patients. The insights of this study can be used to adapt the health care system toward a new type of health information-seeking behavior in which one medium is not trusted to fulfill all needs. Instead, providers should incorporate the intertwinement of sources by providing patients with reliable websites and forums through which they can fulfill their needs.