Health Information as "Fodder for Fears": A Qualitative Analysis of Types and Determinants of the Nonuse of Health Information.

As not all individuals are willing to pay attention to health information it is crucial to understand and distinguish the underlying motives and the scope of various nonuse behaviors. To increase conceptual clarity and specify theoretical assumptions about the types of nonuse of health information and their determinants, we used a qualitative research approach. Semi-structured interviews with 11 female, 10 male, and 10 non-binary participants aged between 18 and 67 (M = 39.7) showed that information ignoring and avoidance are two distinct behaviors characterized by their motivational patterns. Information ignoring is a preference for other content, serving as a strategy to manage limited time resources and receptivity. Information avoidance is understood as a decision to avoid threatening health information serving emotion regulation. Our data further indicate that information ignoring and avoidance are not unidimensional constructs. Instead, the selectivity and consistency of both behaviors build various types of information ignoring and avoidance, which need to be explained differently considering individual differences, cognitive, affective, socio-normative, and structural factors. Further, theory specification should build on the revealed findings and test which factors relate to which kind of nonuse behaviors.

Clarifying the Relationship Between Information Seeking and Avoidance: Longitudinal Analyses of Information Behaviors and Their Normative Influences.

Information seeking and avoidance are relevant behaviors to cope with health crises. While there are various assumptions about their relationship, past research has not yet analyzed their interplay. The present study aims to clarify the relationship between information seeking and avoidance in the course of the COVID-19 pandemic and shed light on whether both behaviors are impacted by seeking- and avoidance-related norms, which are known factors in individuals' health- and risk-related behaviors. Based on a four-wave panel study conducted among German residents (n = 492), we investigated information seeking and avoidance and their normative influences from a longitudinal perspective. Results of random intercept cross-lagged panel models suggest that information seeking and avoidance are distinct, not causally related but correlated concepts. This understanding is supported by the findings that seeking- and avoidance-related norms operate differently for seeking and avoidance. The results add to construct clarification and theory development, but more research is needed to understand the relations between information behaviors.

Explaining Seeking, Scanning, and Avoidance of Information About the Mammography-Screening: Results of a Two-Wave Online Survey with a Stratified Sample of Women.

Whether individuals engage with or avoid health information and which sources are used is crucial for informed decision-making about mammography. Therefore, we aim to develop a typology of mammography-related information behaviors and explore their determinants, which were derived from the Theory of Motivated Information Management (TMIM). Based on a two-wave online survey of a sample of German women aged 40 to 69 years (N = 1,138), a cluster analysis resulted in five person-centric types of information behavior that cover respondents' variety of engagement with mammography-related information: The seekers, the scanners, the avoiders, the involved, and the inactive. The types indicated that most individuals possess a high preference for one strategy of information behavior. Looking at the determinants of belonging to a particular type of information behavior, it becomes apparent that the factors of the TMIM have only limited explanatory power. The most relevant factors in distinguishing the types of information behaviors are benefit perceptions, worry, interest, avoidance efficacy, seeking, and avoidance-related outcome expectancies. Scanners and seekers had higher benefit perceptions. Seekers were further motivated by greater worries, while involved ones felt more interested and held stronger expectancies. Avoiders were more anxious and had a higher avoidance efficacy. The study suggests that inactive individuals and avoiders are highly prevalent and relevant target groups for health interventions that support informed decision-making. To facilitate informed decision-making, women should be encouraged to weigh benefits and harms of their options and to address negative emotions, such as anxiety, that may exist or arise during decision-making.

Search Engine Use for Health-Related Purposes: Behavioral Data on Online Health Information-Seeking in Germany.

Internet searches for health-related purposes are common, with search engines like Google being the most popular starting point. However, results on the popularity of health information-seeking behaviors are based on self-report data, often criticized for suffering from incomplete recall, overreporting, and low reliability. Therefore, the current study builds on user-centric tracking of Internet use to reveal how individuals actually behave online. We conducted a secondary analysis of passively recorded Internet use logs to examine the prevalence of health-related search engine use, the types of health information searched for, and the sources visited after the searches. The analysis revealed two key findings. 1) We largely support earlier survey-based findings on the prevalence of online health information seeking with search engines and the relatively minor differences in information-seeking behaviors between socio-demographic groups. 2) We provide a more granular picture of the process of HISB using search engines by identifying different selection patterns depending on the scope of the searches.

Outcomes of Information Seeking and Avoidance Behaviors: Insights from a German Longitudinal Study.

Examining information behaviors is often justified by their consequences but theoretical models of information behaviors have focused on antecedents of seeking and avoidance rather than their outcomes. Therefore, the current study aims to explore the affective, cognitive, and behavioral consequences of information-seeking and avoidance behaviors related to the COVID-19 pandemic. Based on a secondary analysis of a four-wave online survey of a sample of German residents (n = 492), we conducted hybrid models allowing us to differentiate between within-person effects of information behaviors on the outcomes and between-person correlations between information behaviors and outcomes. The findings revealed only single and small effects of information behaviors. Cognitive consequences such as risk perceptions were influenced by information seeking, whereas information seeking and avoidance affected individuals' subjective but not their objective level of knowledge. Neither information seeking nor avoidance impacted affective responses or a variety of behavioral consequences. These results contrast with assumptions that information seeking is per se a desirable health outcome, whereas information avoidance might be a barrier to health prevention and pandemic containment. At least in times of a health crisis, the findings suggest that information behavior might not be the central determinant of various affective, cognitive, and behavioral outcomes.

Avoidance of Interpersonal Discussions About the COVID-19 Vaccination: Applying the Theory of Motivated Information Management.

Using a stratified sample of German non-vaccinated residents (N = 1,328), we examined the effectiveness of the Theory of Motivated Information Management (TMIM) in explaining avoidant information management among family and friends, in the context of the COVID-19 vaccination. Our results generally supported the TMIM's utility as a theoretical framework for understanding avoidant information management, as the model fitted the data well. The study contributes to the theoretical development of the TMIM, by proving that anxiety and hope operate jointly and contribute to decisions for avoiding interpersonal discussions. Further, our findings indicate that avoidance efficacy is a valuable supplement to the considered types of efficacy assessments. As a practical implication, our findings indicate that interventions encouraging individuals to talk to their family and friends should focus on raising levels of communication and target efficacy, to overcome barriers to interpersonal discussions. This is significant in motivating individuals to get vaccinated.

The Planned Risk Information Seeking Model Applied to Vaccine Information Avoidance and the Role of Affect, Emotion and Perceived Benefits.

Using a stratified sample of German residents (N = 1,508), we examined intentions to avoid information about vaccination against COVID-19. The study was guided by the planned risk information seeking model (PRISM), also taking into consideration benefit perceptions, positive affective responses, and discrete emotions. Our findings generally supported the utility of the extended PRISM to predict information avoidance intentions; most of the hypothesized relationships were supported and the model accounted for 58.8% of the variance in intentions to avoid information about COVID-19 vaccination. Furthermore, perceived benefits of vaccination, and positive affect felt toward vaccination played significant roles in explaining intentions to avoid information about vaccination. A more nuanced view on affective predictors showed that hope and interest were weakly associated with less pronounced avoidance intent, whereas we found no link between avoidance intent and fear, anxiety, and anger.

Health Information Repertoires of Implant Patients: Toward a Deeper Understanding of Multiple Source Use and the Role of Health-Related Motives.

Health information-seeking behavior can be understood as an active and purposeful acquisition of information from selected information sources. It supports patients to cope with medical and health-related uncertainties and enables them to engage in informed decision-making. To obtain health information, patients can turn to a variety of sources, such as going to a physician, exchanging information with their family, or using different Internet sources. Research showed that patients typically use multiple sources to meet their health-related information needs. To attain a holistic and differentiated picture of patients' actual health information behavior, the current study draws on the repertoire approach. We conducted an online survey with 1,105 implant patients and performed a cluster analysis to explore their health information repertoires. To gain a deeper understanding of the practical meaning behind the repertoires, we also considered health-related information motives and socio-structural factors, as well as the implant type (dental, orthopedic, cochlear), to characterize the repertoires. The study revealed seven different health information repertoires of implant patients, varying in their combination of multiple sources used. In addition, group comparisons showed that the repertoires differ significantly regarding socio-structural factors, such as gender, age, and education, as well as implant type. Furthermore, information motives contribute significantly to the differentiation of the repertoires. The results are of high theoretical potential for communication science as well as practical use for strategic health communication.

A Comparison of Women's and Men's Web-Based Information-Seeking Behaviors About Gender-Related Health Information: Web-Based Survey Study of a Stratified German Sample.

BACKGROUND: Gender-sensitive approaches to health communication aim to integrate gender perspectives at all levels of communication, as an individual's biological sex and socially assigned gender identity have an impact on whether and how one acquires what type of health information. Due to the fast and low-cost opportunity to search for a wide range of information, the internet seems to be a particularly suitable place for gender-related health information about diseases of sex-specific organs and diseases where biological differences are associated with different health risks. OBJECTIVE: This study aims to inform gender-related information provision and acquisition in 2 ways. The first objective was to provide a theory-driven analysis of web-based health information-seeking behavior (HISB) regarding gender-related issues. Therefore, the Planned Risk Information Seeking Model (PRISM), which is one of the most integrative models of HISB, was adapted and applied. Second, we asked for gender-specific motivational determinants of gender-related web-based HISB comparing the predictors in the groups of women and men. METHODS: Data from a stratified web-based survey of the German population (N=3000) explained gender-related web-based HISB and influencing patterns comparing women and men. The applicability of PRISM to gender-related web-based HISB was tested using structural equation modeling and a multigroup comparison. RESULTS: The results revealed PRISM as an effective framework for explaining gender-related web-based HISB. The model accounted for 28.8% of the variance in gender-related web-based HISB. Gender-related subjective norms provided the most crucial explanatory power, followed by perceived seeking control. The multigroup comparison revealed differences in the model's explanatory power and the relevance of predictors of gender-related web-based HISB. The share of explained variances of web-based HISB is higher in men than in women. For men, norms were a more relevant promoting factor, whereas web-based HISB of women was more strongly associated with perceived seeking control. CONCLUSIONS: The results are crucial for gender-sensitive targeting strategies and suggest gender-related health information interventions that address gender-related subjective norms. Furthermore, programs (eg, web-based learning units) should be developed and offered to improve individuals' (perceived) abilities to perform web-based searches for health information, as those with higher control beliefs are more likely to access web-based information.

Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study.

BACKGROUND: Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one's state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm. OBJECTIVE: This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users' perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions. METHODS: Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions. RESULTS: Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one's state of health, and preventing health problems. In total, 66.62% (1333/2001) of internet users engaged in this behavior. Health care-related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition). CONCLUSIONS: Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key.

[Digital personalized health information services from physicians: survey results of patients' and physicians' acceptance and expectations]. / Digitale, personalisierte Gesundheitsinformationsangebote von Ärzt*innen: Ergebnisse einer Befragung von Patient*innen und Ärzt*innen zu Akzeptanz und Anforderungen.

BACKGROUND: The acquisition of health information is fundamental for patient empowerment. In order to support this, new ways of providing information must be found. In this article, the digital personalized provision of health information by physicians as well as the intended use and requirements of patients and physicians are examined. METHODS: An online survey of a sample of patients stratified for the German population (N = 1,000) and an online survey of physicians (N = 364) on the subject of digital personalized health information services were conducted. The type of information provision in the medical setting, the intention to use it, and the requirements for digital information services were assessed. RESULTS: Digital personalized information services are still rare. However, patients would support such a service, while physicians are more skeptical. Patients value usability and information quality. With regard to the form of presentation, texts tend to be rated more important than videos. For physicians, on the other hand, it is important that the service comes from a trustworthy provider, complies with guidelines, and is free of charge. DISCUSSION: The potential of the digital transformation of information provision has so far only been utilized to a limited extent. While the basis for successful implementation seems to be given among patients, physicians still need to overcome their reservations, the benefits of such services need to be communicated, and systemic incentives must be created.

[A gendered perspective of information behaviors, its drivers, and barriers : Results of an online survey of a sample stratified for the German population]. / Ein geschlechterspezifischer Blick auf das gesundheitsbezogene Informationshandeln, seine Treiber und Barrieren : Ergebnisse einer Online-Befragung einer für die deutsche Bevölkerung stratifizierten Stichprobe.

BACKGROUND: The gender perspective is an essential level of effective health communication approaches. Against the background of the gender perspective as an essential level of effective health communication approaches, we focus on health-related information behaviors. Complementary to information seeking, information avoidance is included. Both forms of information behavior are described in gender-specific ways, and their predictors are identified using a resource-centered approach covering the individual's health, empowerment, involvement, and social support. METHOD: An online survey of a sample stratified for the German population (N = 3000) was conducted. The two modes of information behavior as well as their theoretically derived predictors were assessed. In addition to descriptive analyses, blockwise regression analyses were used to identify gender-specific predictors of information seeking and avoidance. RESULTS: Information seeking occurs more frequently than information avoidance. Both differ only slightly between men and women and showed the strongest correlations with the respondents' involvement. For information seeking, coping resources are also a significant predictor, while information avoidance is associated with psychological well-being and social support. Similar patterns of association emerge across genders. CONCLUSION: Across genders, it is evident that health communication measures should strengthen the involvement of the population and their coping resources to promote information seeking and counteract information avoidance. Additionally, the findings revealed that avoiders should be more focused as one of the main target groups of health communication.

[Sharing information on COVID-19 vaccination: quantitative online survey on actors, content, sources, and motives]. / Informationsweitergabe zur COVID-19-Impfung: Quantitative Online-Befragung zu Akteuren, Inhalten, Quellen und Motiven.

BACKGROUND: A person's opinion about COVID-19 vaccination and their decision for or against the vaccination are determined, among other things, by the information they receive. Therefore, it seems crucial to examine the phenomenon of information sharing in the context of COVID-19 vaccination. The study explores who shares which information about vaccinations with whom, how the sharing of information is related to the seeking of information from various sources, and what the motives are. METHOD: From 19 June to 13 July 2021, we conducted an online survey with 833 people using the German non-representative Social Sciences' (SoSci) panel. The questionnaire assessed information sharing with strangers and the social environment, the content, and the motives as well as the sources of information. The responses of 828 people were evaluated using descriptive statistics and multiple linear regression analyses. RESULTS: Older people, women, and unvaccinated individuals were more likely to share information about COVID-19 vaccination. Information was more often shared in the social environment than with strangers. People shared information about benefits and risks of the vaccination as well as their own experiences with vaccinations. People who research websites of health authorities were more likely to share information about the benefits of vaccinations and their own experiences, while people using YouTube or messenger services were more likely to share information about risks. The motives for sharing information are to help others, social exchange, to raise awareness, to gain status, and the fear of being attacked or judged. CONCLUSION: Information sharing on COVID-19 vaccination is complex in terms of content and motivation. In order to promote vaccination readiness, the range of information offered by public health departments should be expanded and the population's health literacy should be strengthened.

Explaining cancer information avoidance comparing people with and without cancer experience in the family.

OBJECTIVES: Cancer information avoidance (CIA) serves as a barrier to preventive efforts. To learn how to combat this barrier, we aim to examine predictors of CIA in populations with and without cancer experience in the family, which are addressed differently in cancer prevention, according to specific informational barriers. METHODS: A subsample of people with and without cancer in the family (n = 2,757) of an online survey with a sample stratified for the German population by age, gender, education, and region was conducted via an online access panel. The survey instrument was adapted from the Health Information National Trends Survey. Separate stepwise regression analyses were conducted. RESULTS: Only a comparatively small proportion of the variance in CIA was explained by the predictors, ranging from R2  = .148 for people without cancer experience to R2  = .180 for participants with cancer experience in their family. Across the groups, the findings showed that people who were fatalistic about the risk of cancer, less health literate, who perceived less social pressure to be informed, and were less trusting in information sources more often avoided cancer information. CONCLUSIONS: Our findings identify relevant target groups to be addressed and barriers to be removed for cancer communication efforts. Adequate information provision can be supported by programs for fostering health literacy and social network diffusion strategies.

OnkoRiskNET: a multicenter, interdisciplinary, telemedicine-based model to improve care for patients with a genetic tumor risk syndrome.

BACKGROUND: Genetic tumor risk syndromes are responsible for at least five to ten percent of the 4 million cases of cancer diagnosed in Europe every year. Currently, the care of oncological patients suffers from a lack of specialists in medical genetics and also a lack of access to genetic care in rural areas and structured care pathways between oncologists and medical geneticists. As a result, genetic tumor risk syndromes are underdiagnosed with potentially fatal consequences for patients and their families. METHODS: The OnkoRiskNET study is supported by a grant from the Federal Joint Committee of the Federal Republic of Germany. The study will include 2,000 oncological index patients from oncology practices in Lower Saxony and Saxony after the start of the study in July 2021. Randomization is carried out by means of a stepped wedge design at the level of the practices. Patients either go through routine care or the new form of care with structured cooperation between medical geneticists and oncologists, case management and the use of telemedical genetic counseling. Using a mixed-methods approach, the following parameters will be evaluated in the control and intervention group: (1) Conducted genetic counseling sessions by patients with suspected tumor risk syndrome and their first degree relatives; (2) Patient satisfaction and psychological distress after genetic counseling and testing; (3) Factors influencing the acceptance and experience of telemedical genetic counseling; (4) Satisfaction of oncologists and medical genetics with the structured pathway; (5) Cost efficiency of the new form of care. DISCUSSION: OnkoRiskNET aims to close the gap in care through the formation of a cooperation network between practicing oncologists and specialists in medical genetics and the use of telemedical genetic counseling, thereby, increasing the diagnostic rate in genetic tumor risk syndromes and serving as a model for future genetic care in Germany. TRIAL REGISTRATION: Trial was registered on 01.12.2021 in the German Clinical Trial Register ( https://trialsearch.who.int/ ) with the DRKS-ID:  DRKS00026679 . TITLE: Cooperation network for the provision of local care for patients and families with a genetic tumour risk syndrome. Trial acronym: OnkoRiskNET. Protocol version 1.1.

Expanding the Health Information National Trends Survey Research Program Internationally to Examine Global Health Communication Trends: Comparing Health Information Seeking Behaviors in the U.S. and Germany.

The Health Information National Trends Survey (HINTS) is a well-established U.S.-based research program administered by the National Cancer Institute to track the public access to and use of health information. This paper introduces a German research initiative, part of the International Studies to Investigate Global Health Information Trends (INSIGHTS) research consortium. This adaptation of the HINTS is important for initiating analyses of global health communication practices and comparing health information seeking behaviors (HISB) across nations to pinpoint potentials and challenges of health information provision and contribute to a deeper understanding of socio-contextual determinants of HISB. First cross-country comparisons revealed that the share of residents seeking for health information is high in the U.S. (80%) and Germany (74%), but different primary sources are used. Whereas a clear majority of U.S. residents chose the Internet to gather health information (74.9%), Germans most often turn to health professionals (48.0%). Socio-structural and health(care)-related predictors were found to contribute to the explanation of HISB in both countries, whereas information-related predictors were only relevant in Germany. The results indicate the need to engage in patient-provider communication to initiate HISB and to improve the access to information for residents with lower socio-economic backgrounds.

Correlates of the perceived quality of patient-provider communication among German adults.

BACKGROUND: Since a higher perceived quality of patient-provider communication is known to be associated with improved health outcomes, it is essential to analyze determinants influencing patients' perceived quality of patient-provider communication. Due to the limited knowledge about patient-related influencing factors of quality perception available so far, the objective of this study is to explore and assess determinants of the perceived quality of patient-provider communication with regards to sociodemographic, health-related, healthcare-specific and information-related factors. METHODS: Linear regression of cross-sectional data from the first wave of Health Information National Trends Survey Germany (n = 2902) was conducted. Independent variables were sociodemographic, health-, healthcare- and information-related factors; the dependent variable was the perceived quality of patient-provider communication. RESULTS: Results show that age, migration background, the perceived quality of healthcare, health-related self-efficacy and trust in health information from health professionals are significantly associated with the perceived quality of patient-provider communication. CONCLUSIONS: Sociodemographic, healthcare- and health information-related factors influence the perceived quality of patient-provider communication. In particular, patients having a migration background and patients reporting low self-efficacy showed significant lower levels of their perceived patient-provider communication quality. With the aim to improve quality issues, patients of both target groups should be empowered and supported.

Explaining Online Information Seeking Behaviors in People With Different Health Statuses: German Representative Cross-sectional Survey.

BACKGROUND: Worldwide, the internet is an increasingly important channel for health information. Many theories have been applied in research on online health information seeking behaviors (HISBs), with each model integrating a different set of predictors; thus, a common understanding of the predictors of (online) HISB is still missing. Another shortcoming of the theories explaining (online) HISB is that most existing models, so far, focus on very specific health contexts such as cancer. Therefore, the assumptions of the Planned Risk Information Seeking Model (PRISM) as the latest integrative model are applied to study online HISB, because this model identifies the general cognitive and sociopsychological factors that explain health information seeking intention. We shift away from single diseases and explore cross-thematic patterns of online HISB intention and compare predictors concerning different health statuses as it can be assumed that groups of people perceiving themselves as ill or healthy will differ concerning their drivers of online HISB. Considering the specifics of online HISB and variation in individual context factors is key for the development of generalizable theories. OBJECTIVE: The objective of our study was to contribute to the development of the concept of online HISB in 2 areas. First, this study aimed to explore individual-level predictors of individuals' online HISB intention by applying the postulates of PRISM. Second, we compared relevant predictors of online HISB in groups of people with different health statuses to identify cross-thematic central patterns of online HISB. METHODS: Data from a representative sample of German internet users (n=822) served to explain online HISB intentions and influencing patterns in different groups of people. The applicability of the PRISM to online HISB intention was tested by structural equation modeling and multigroup comparison. RESULTS: Our results revealed PRISM to be an effective framework for explaining online HISB intention. For online HISB, attitudes toward seeking health information online provided the most important explanatory power followed by risk perceptions and affective risk responses. The multigroup comparison revealed differences both regarding the explanatory power of the model and the relevance of predictors of online HISB. The online HISB intention could be better explained for people facing a health threat, suggesting that the predictors adopted from PRISM were more suitable to explain a problem-driven type of information-seeking behavior. CONCLUSIONS: Our findings indicate that attitudes toward seeking health information online and risk perceptions are of central importance for online HISB across different health-conditional contexts. Predictors such as self-efficacy and perceived knowledge insufficiency play a context-dependent role-they are more influential when individuals are facing health threats and the search for health information is of higher personal relevance and urgency. These findings can be understood as the first step to develop a generalized theory of online HISB.

Information avoidance during health crises: Predictors of avoiding information about the COVID-19 pandemic among german news consumers.

This study investigates the prevalence of source-specific information avoidance among German consumers and predictors of information-avoidance behavior in the context of the COVID-19 pandemic. Guided by the Risk Information Seeking and Processing Model (RISP), we propose that the perceived social norms, information insufficiency, risk perception, affective risk response, and attitudes toward seeking predict information avoidance. We supplement the RISP model by considering information overload as the vast volume and the incredulous quality of information in the COVID-19 pandemic challenge individuals' information acquisition and processing. Using a stratified demographic sample of news consumers of a federal German state (N = 1,000), we empirically examined the proposed model, answered the research question, and tested our hypotheses using structural equation modeling. The results reveal information avoidance among one-third of the respondents. They avoided online sources, including online-mediated interpersonal sources, more often than interpersonal sources and traditional mass media. Information avoidance was linked to more negative attitudes toward seeking and negative affective risk responses, more pronounced descriptive and injunctive avoidance norms, and perceived information overload. Attitudes and information overload were the most influential predictors of avoidance. In contrast, risk perception and information insufficiency were not associated with information avoidance. This study provides insights into theory development, contributes to the information behavior literature, and identifies barriers to communication during health crises.

[Use of health information on the internet: personal and motivational influencing factors]. / Nutzung von Gesundheitsinformationen im Internet: personenbezogene und motivationale Einflussfaktoren.

BACKGROUND AND OBJECTIVES: Taking an active role in healthcare requires comprehensive health knowledge. One's own online search for health information can contribute to an appropriate information base. Therefore, it seems essential to determine the extent to which online services and health apps are currently used in Germany as well as to analyze which personal and motivational factors influence whether and how often the German public search for health information online or use health apps. METHODS: We conducted an online survey among the German public in a sample stratified by demographic characteristics (N = 3000). The questionnaire measured the health-related use of the Internet and health apps as well as possible personal and motivational factors. The relevance of these factors for explaining the Internet use for health-related purposes was determined by regression analyses. RESULTS: While health-related information searches using the Internet are widespread in Germany, health apps are used less frequently. In particular health information platforms are most frequently used to search for information on disease symptoms. Turning to the Internet for health-related purposes is mainly influenced by motivational factors. Having current health problems and possessing information-seeking skills are particularly influential factors for an individual's Internet use. CONCLUSIONS: In order to unfold the potential associated with health-related online information-seeking behaviors, it is necessary that people are motivated and feel competent to gather online information themselves. In particular, the corresponding skills need to be promoted in order to reduce the risk of increasing informational, health, and social disparities.