eHealth

Timothy M. Hale, Wen-Ying Sylvia Chou, Shelia R. Cotten, Timothy M. Hale, Wen-Ying Sylvia Chou, Sheila R. Cotten

• Publisher: Emerald Publishing Limited
• Year: 2018
• ISBN:
  9781787543232
• Topic: Medizin
• Subtopic: Medizinische Theorie, Praxis & Referenz

This special volume contributes to the rapidly growing body of eHealth research, presenting a selection of multidisciplinary studies on the role and impacts of technology and the Internet in health communication, healthcare delivery, and patient self-management.
The use of the Internet and new communication technologies have impacted nearly every aspect of life in recent years. These technologies hold tremendous promise to improve systems of healthcare and enable people to better understand their health and manage their healthcare. However, there are also risks to the use of eHealth technologies. Empirical evidence is urgently needed to examine the use and impacts of eHealth technologies and to inform targeted health communication interventions.
Chapters explore both old and new challenges associated with technology-enabled care. These include the persistence of social determinants in shaping Digital Divides in access and use of eHealth technologies, the unintended consequences associated with electronic medical records and pagers on healthcare professionals' ability to control their work time, and how self-tracking and quantification may exacerbate gendered norms of the body and health. Other chapters provide updated information on trends in and predictors of people's trust of health information channels, how people make credibility assessments of online health information, the role of personality traits in perceived benefits in online support group participation, and how online health resources impact people's sense of empowerment and the use of healthcare services. Finally, chapters explore the future potential of eHealth in addressing the needs of underserved communities and guide the creation of new technology-enabled intervention strategies.

CHAPTER 1

“I WENT HOME TO GOOGLE”: HOW USERS ASSESS THE CREDIBILITY OF ONLINE HEALTH INFORMATION

Erin Klawitter and Eszter Hargittai

ABSTRACT

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

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

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

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

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

Keywords: Health; credibility assessment; information seeking; search engines; search process; health search

INTRODUCTION

The majority of Americans turn to the Internet every day, seeking information on a variety of topics (Horrigan, 2016; Purcell, Brenner, & Rainie, 2012). While the abundance of information that is available online provides many opportunities and discoveries for everyday users, it also presents unprecedented challenges when it comes to considering and evaluating the credibility of information people encounter (Sundar, 2008). Although a strong foundation of research regarding online credibility assessment exists, it is crucial that scholarship continues to refine its understanding of how users with greater and lesser know-how assess the credibility of online information in light of the ever-changing digital landscape. This is particularly imperative in the domain of health information, given that so many turn to the Internet for critical information regarding medical decision making (Horrigan, 2016; Fox & Duggan, 2013).

In this study, we explore how users differ in their ability to assess the credibility of online health information. With the wealth of information available online, what are the most common strategies that people use to assess health-information credibility and what are the most informed strategies people employ? While much related research tends to set boundaries on the types of online sources users may consult (e.g., specific search engines, social question-asking sites, and other particular sites), our research design is much more encompassing in that it did not impose a priori constraints on where participants could search for answers to the questions we posed to them. Accordingly, we can address questions such as whether the strategies people use on a website differ from those they use while viewing a search engine’s results page. Taking on Metzger’s (2007) call for “a greater variety of research methods, on a greater variety of Internet users, performing a greater variety of search tasks than has been done to date” (p. 2086), this unique mixed-methods study on a diverse group of adults adds important insights into how credibility assessment is currently understood.

Credibility Assessment Online

Scholars have long studied how people evaluate the credibility or “believability” of information both in online and offline contexts (Tseng & Fogg, 1999). Credibility assessment “refers to any attempt to ascertain truthfulness” (Yuille, 1989, p. VII). Such cognitive evaluations are critical because they influence how people come to understand and use the information they encounter (Hovland & Weiss, 1951; McCroskey & Young, 1981; Menchen-Trevino & Hargittai, 2011). While credibility assessment has long been discussed as a necessary skill by educators and researchers (Hargittai, 2007; Jenkins, Clinton, Purushotma, Robison, & Weigel, 2006; Metzger, 2005), the vast amount of information on the web combined with the ability for anyone to add to the existing material has made credibility evaluation online even more complex and challenging than in traditionally mediated contexts (Sundar, 2008).

Scholars have proposed several different theoretical models to describe how people make sense of information online (Fogg, 2003; Fritch & Cromwell, 2001; Jessen & Jorgensen, 2012; Lucassen & Schraagen, 2012; Metzger, Flanagin, & Medders, 2010; Wathen & Burkell, 2002). For example, Prominence-Interpretation Theory (Fogg, 2003; Wathen & Burkell, 2002) suggests that when people approach a site, they notice and begin to judge its “prominent” elements, such as its images. They iteratively assess a variety of features until they form an “overall assessment of credibility” (Fogg, 2003, p. 722). Wathen and Burkell (2002) proposed that when people get to a site, they first assess the site’s “surface credibility” based on factors like the site’s appearance, usability, and organization, and then they move on to evaluate the site’s message based on factors like its source and relevance.

However, additional research suggests that credibility assessment can be much less systematic. Assessing an abundance of information often conflicts with users’ lack of skills and/or time (Klawitter & Hargittai, in press; Taraborelli, 2008), therefore many people rely on cognitive heuristics, “short cuts, rules-of-thumb, or guidelines that reduce cognitive load during information processing and decision-making” (Metzger et al., 2010, p. 417). This is perhaps why much research focuses on heuristic cues, such as a site’s layout and design (Flanagin & Metzger, 2007; Fogg et al., 2003; Gasser, Cortesi, Malik, & Lee, 2012; Hove, Paek, & Isaacson, 2011; Sundar, 2008; Tombros, Ruthven, & Jose, 2005; Wathen & Burkell, 2002), or brand or sponsor (Hargittai, Fullerton, Menchen-Trevino, & Thomas, 2010; Hove et al., 2011; Westerwick, 2013). Additionally, as web pages increasingly incorporate user-generated features, such as comments and reviews, research suggests that users rely on social feedback for their evaluations (Flanagin & Metzger, 2013; Flanagin, Metzger, Pure, & Markov, 2011; Jessen & Jorgensen, 2012; Metzger & Flanagin, 2011; Metzger et al., 2010; Sundar, 2008; Walther, Liang, Ganster, Wohn, & Emington, 2012), adding a layer of complexity.

In order to control for context, which may impact the credibility-­assessment process (Eastin, 2001; Flanagin & Metzger, 2000; O’Keefe, 2002), this study focuses on the health domain. The Internet has played an important role in people’s everyday health queries (Cotten & Gupta, 2004; Fox & Fallows, 2003; Fox & Rainie, 2002; Horrigan, 2016; van Deursen, 2012), and is sometimes an even more important source of information than traditional sources, including medical professionals (Dobransky & Hargittai, 2011; Escoffery et al., 2005; Percheski & Hargittai, 2011). People actively search for answers to health-related queries. Information they retrieve can have significant consequences. For example, a British newspaper reported that one family tried to treat a gunshot wound using information from WebMD.com (Daily Mail Reporter, 2013). The mother waited seven hours before seeking medical attention for her son, choosing to rely on online sources rather than immediately seeking professional help. As a Pew Research Center report noted:

a great many health seekers say the resources they find on the Web have a direct effect on the dec...