How Does Online Patient-Provider Communication Heal? Examining the Role of Patient Satisfaction and Communication Experience in China

How do electronic personal health information technologies enhance obesity prevention behaviors? Examining the roles of obesity risk perception and body weight

BACKGROUND

The global epidemic of overweight and obesity appears alongside numerous diseases. As electronic personal health information (ePHI) technology becomes more prevalent, understanding its relationship with health behaviors and how this relationship may differ across physical groups becomes increasingly relevant.

METHODS

Using secondary data from the National Cancer Institute's Health Information National Trends Survey (HINTS) 2020, this study examined the relationships between ePHI technology use, obesity preventive behaviors (e.g., physical activity, alcohol consumption, and diet control), and risk perception of obesity, considering body weight as a potential moderator.

RESULTS

The patterns between ePHI technology use and obesity preventive behaviors differed across behavior types and body weight groups. Higher ePHI technology use was associated with increased physical activity (b = 5.98, bp = 0.44, p < .01) and diet control (b = 0.03, bp = 0.28, OR = 1.11, p < .001), while no significant relationship was observed with alcohol consumption. The relationship between ePHI technology use and risk perception of obesity was weaker among the obese group (b = -0.03, bp = -0.11, p < .05). The indirect relationship between ePHI technology use and physical activity varied by body weight, showing stronger associations in the underweight group (95% CI [0.03, 2.77]) and weaker associations in the obese group (95% CI [-1.14, -0.04]).

CONCLUSION

The findings suggest more limited relationships between ePHI technology and health behaviors than previously anticipated. Physical activity and dietary regulation showed modest associations with ePHI technology use, while alcohol consumption showed no significant relationship. Overweight and obese individuals did not show a higher risk perception of obesity or greater engagement in preventive behaviors compared to those of healthy weight. These findings highlight the importance of developing a more nuanced understanding of ePHI technology's role in health-related contexts.

What Key Factors Affect Patient Satisfaction on Online Medical Consultation Platforms? A Case Study from China

Background/Objectives: Online medical consultation (OMC) platforms have become an essential tool for facilitating communication between doctors and patients, providing an efficient way for patients to access healthcare services. However, research on the key drivers of patient satisfaction within this context remains limited. This study aims to identify and prioritize the key factors influencing patient satisfaction on OMC platforms, with a focus on the Chinese "Chunyu Doctor" app as a case study. Methods: Data from patient comments on the "Chunyu Doctor" app were collected and analyzed using grounded theory to identify the influencing factors of patient satisfaction. The decision-making trial and evaluation laboratory (DEMATEL) method was then applied to assess and prioritize the factors influencing patient satisfaction, identifying the key determinants from a complex set of potential influences. Results: The study identified 11 key factors out of 23 that significantly impact patient satisfaction. These factors include doctors provide professional treatment plans, doctors accurately understand patients' concerns, doctors explain and advise on prescriptions, doctors personally respond, doctors provide comprehensive replies, cost-effectiveness, consultation fees, effectiveness of treatment outcomes, reasonableness of the doctors' consultation process, avoidance of templated responses by doctors, and alignment of doctors responses with patient expectations. Conclusions: This study enriches the understanding of patient satisfaction in the context of online medical consultations. The findings offer theoretical insights for future research and provide practical implications for enhancing the management and development of OMC platforms, improving the quality of healthcare services, and boosting patient satisfaction.

Following Medical Advice of an AI or a Human Doctor? Experimental Evidence Based on Clinician-Patient Communication Pathway Model

Medical large language models are being introduced to the public in collaboration with governments, medical institutions, and artificial intelligence (AI) researchers. However, a crucial question remains: Will patients follow the medical advice provided by AI doctors? The lack of user research makes it difficult to provide definitive answers. Based on the clinician-patient communication pathway model, this study conducted a factorial experiment with a 2 (medical provider, AI vs. human) × 2 (information support, low vs. high) × 2 (response latency, slow vs. fast) between-subjects design (n = 535). The results showed that participants exhibited significantly lower adherence to AI doctors' advice than to human doctors. In addition, the interaction effect suggested that, under the slow-response latency condition, subjects perceived greater health benefits and patient-centeredness from human doctors, while the opposite was observed for AI doctors.

Turning to digital: Examining the relationship between offline healthcare barriers and U.S. older adults' emotional well-being via online patient-provider communication and perceived quality of care (2017-2020)

Purpose

To examine the association between offline healthcare barriers and emotional well-being and assess the mediation roles of online patient-provider communication (OPPC) and perceived quality of care. This study also investigates the trends in offline healthcare barriers, OPPC, perceived quality of care, and emotional well-being over four years among the old population in the U.S.

Methods

Data from the Health Information National Trends Survey (HINTS) 5 Cycles 1, 2, and 4 were used. Mediation analysis and comparison analysis were employed.

Results

The results indicated an increment in OPPC and a decline in patient's perceived quality of care between 2017 and 2020. Across the three years, offline healthcare barriers were consistently negatively associated with emotional well-being, and perceived quality of care remained a mediator in such a relationship. Moreover, the serial mediating roles of OPPC and perceived quality of care between offline healthcare barriers and emotional well-being turned from statistically non-significant (2017) to significant (2018, 2020).

Conclusion

Our results witness the growing adoption of OPPC among older adults and the evolution of OPPC as a complementary communication modality. The findings can support interventions to augment OPPC utilization and enhance the perception of quality care of older adults, contributing to their increased emotional well-being.

Online patient-provider communication and healthy ageing: the roles of health literacy and health self-efficacy

eHealth involves using digital technologies, like electronic health records and telemedicine, to enhance healthcare delivery and outcomes. For older adults, eHealth helps manage chronic conditions, access services remotely, and engage in preventive health, improving physical and psychological well-being. This study investigates the association between online patient-provider communication (OPPC) and older adults' quality of life (QoL, i.e. sleep quality, exercise and psychological health). The study also explores how health literacy and health self-efficacy mediate the relationship between OPPC and QoL. This study utilized data from the National Cancer Institute's Health Information National Trends Survey, collected in 2019 (HINTS 5 Cycle 3), specifically targeting individuals aged ≥ 60 (N = 2587). The associations among variables were analysed using structural equation modelling. OPPC was positively and significantly associated with health literacy (β = 0.53, p < 0.001). Health literacy was positively and significantly related to health self-efficacy (β = 0.02, p < 0.001). Health self-efficacy was significantly related to five dimensions of QoL: sleep quality (β = 0.20, p < 0.001), fruit and vegetable consumption (β = 0.13, p < 0.010), exercise (β = 0.59, p < 0.001), sedentariness (β = -0.58, p < 0.001) and psychological health (β = 0.24, p < 0.001). Besides, health literacy and health self-efficacy also mediated the influence of OPPC on QoL sequentially, being identificators as two serial mediators between OPPC and older adults' QoL. This study suggests that OPPC plays an important role in older adults' QoL.

Examining the Intervening Roles of Patient-Centered Care and Patient Activation in the Health Impacts of Offline Healthcare Obstacles and Online Health Consultations Among Deaf and Hard-of-Hearing Patients

Deaf and hard-of-hearing (DHH) patients often encounter difficulties in effective communication with healthcare professionals and are less likely to receive quality medical care. However, DHH populations are understudied in health communication research. This study examined how offline healthcare obstacles and online health consultation impact DHH patients' health, and the mediating roles of patient-centered care (PCC) and patient activation. Data from 323 DHH patients were analyzed using structural equation modeling to test the hypothesized mediation pathway model. Results indicate that offline healthcare obstacles negatively affect DHH patients' perception of patient-centeredness, which reduces their ability and confidence in self-care (conceptualized as patient activation in this study). This reduced patient activation may jeopardize DHH patients' physical and psychological health. Meanwhile, online health consultation is positively associated with PCC, and higher levels of PCC can increase patient activation, contributing to better physical and psychological health. Testing the same model with hearing-abled participants (n = 3542) revealed significant differences in these intervening relationships. Overall, this study provides valuable insights into the relationship between DHH patients' healthcare experience and their health outcomes. The findings support interventions that focus on enhancing PCC and patient activation to improve the physical and psychological health outcomes of DHH patients.

Pathways Linking Online Physician-Patient Communication to Health Outcomes

Online platforms have proliferated in response to the increasing demand for online medical services. However, the underlying mechanisms through which online physician‒patient communication are associated with better health outcomes are under-researched. We employed mixed focus groups and in-depth interviews to investigate the impact of online physician‒patient communication on health outcomes, including psychological and physical quality of life, as well as perceived diagnosticity. A modified pathway framework was subsequently generated to illustrate the relationship between online communication and health outcomes based on the clinician‒patient communication pathway model. Overall, we redefined the concept of perceived diagnosticity in online healthcare and identified an indirect pathway through which psychological quality of life affects physical quality of life mediated by perceived diagnosticity.

Exploring the Impact of Online Medical Team Engagement on Patient Satisfaction: A Semantic Features Perspective

Online medical teams (OMTs), a new mode of online healthcare service, have emerged in online health communities (OHCs) in China. This study attempts to explore the underlying mechanism of how OMTs' engagement influences patient satisfaction through the lens of semantic features. This study also scrutinizes the moderating effect of multiple specializations on the link between OMTs' engagement and semantic features. We utilized a linear model that had fixed effects controlled at the team level for analysis. A bootstrapping approach using 5000 samples was employed to test the mediation effects. The findings reveal that OMTs' engagement significantly improves language concreteness in online team consultations, which subsequently enhances patient satisfaction. OMT engagement has a negative impact on emotional intensity, ultimately decreasing patient satisfaction. Multiple specializations strengthen the impact of OMT engagement on both language concreteness and emotional intensity. This study contributes to the literature on OMTs and patient satisfaction, providing insights into patients' perceptions of OMTs' engagement during online team consultation. This study also generates several implications for the practice of OHCs and OMTs.

Internet-based eHealth technology for emotional well-being among the older adults with a family cancer history: full mediation effects of health information self-efficacy and cancer fatalism

BACKGROUND

Older adults with a family cancer history (FCH) face an increased cancer risk, which may adversely impact their emotional well-being. Internet-based eHealth technologies (IETs) provide a potential solution to this challenge. This study examines the influence of using IETs on the emotional well-being of older adults with FCH. It also delves into the mediating pathways through health information self-efficacy and cancer fatalism.

METHODS

This study conducted a mediation analysis using data from the Health Information National Trends Survey (HINTS 6) collected from March 2022 to November 2022, focusing on older adults with FCH who had previously searched for cancer-related information (N = 1,280).

RESULTS

In the mediation model, no positive direct associations between IETs usage and emotional well-being were found. Only health information self-efficacy and cancer fatalism were found to mediate the relationship between IETs usage and emotional well-being serially (β = 0.007, 95% CI [0.003, 0.012]).

CONCLUSIONS

The findings inform health information professionals and healthcare practitioners on enhancing the impact of IETs usage on individual health information self-efficacy, which mitigates cancer fatalism, contributing to better emotional well-being in the digital era.

Consulting doctors online after offline treatment: investigating the effects of online information on patients' effective use of online follow-up services

Introduction

The use of online follow-up services (OFUS) is becoming an increasingly important supplement to hospital care. Through OFUS, patients can find their doctors in online health communities (OHCs) and receive remote medical follow-ups after hospital treatment. However, the rate of effective use of OFUS by current patients is still low, and there is an urgent need for research to investigate the online information factors that affect patients' effective use of OFUS.

Methods

Based on the elaboration likelihood model (ELM) of persuasion and an analysis of a panel dataset including 3,672 doctors in a leading OHC in China, this study explores how online information from doctors' knowledge contributions and patient feedback influences patients' effective use of OFUS.

Results

The results show that both doctors' knowledge contributions and patient feedback positively influence patients' effective use of OFUS. Doctors' paid knowledge contributions and patients' paid feedback have stronger persuasive effects than doctors' free knowledge contributions and patients' free feedback, respectively. Moreover, there is a substitutional relationship between doctors' paid and free knowledge contributions and between patients' paid and free feedback in influencing patients' effective use of OFUS.

Discussion

The findings of this study suggest that OHC platforms and healthcare providers should account not only for the persuasive effects of doctors' knowledge contributions and patient feedback but also for influential differences and relationships between the types of doctors' knowledge contributions and patient feedback to better persuade patients to effectively use OFUS.

Overcoming obstacles to mammography screening: Examining the role of offline healthcare barriers and online patient-provider communication

Barriers to accessing offline healthcare may discourage patients from undergoing mammography screening. Online patient-provider communication (OPPC) offers a supplementary health resource that can complement traditional medical encounters and facilitate mammography screening. This study examines how offline healthcare barriers influence mammography screening, taking into account OPPC as an independent variable and cancer fatalism and patient activation as two mediators. Data from the 2017, 2018, and 2020 iterations of the Health Information National Trends Survey were used for this study. Results showed that OPPC was positively linked to mammography screening. Offline healthcare barriers had a negative association with patient activation and subsequent mammography behaviors. Moreover, offline healthcare barriers and OPPC were associated with mammography screening through serial mediation of cancer fatalism and patient activation. This study has important implications for encouraging mammography screening.

How do provider communication strategies predict online patient satisfaction? A content analysis of online patient-provider communication transcripts

Objective

As a result of the growing access to the Internet, online medical platforms have gained increased popularity in China. However, which strategies doctors should use to improve their online communication with patients remains understudied. Drawing upon the performance-evaluation-outcome (PEO) model, the present study seeks to develop a typology of patient-centered communication (PCC) strategies online and identify those strategies that can increase patient satisfaction.

Methods

We employed the data crawling technique to access text-based patient-provider transcripts through a large medical consultation platform in China and coded 9140 conversational turns of doctors.

Results

Our analysis revealed 15 PCC strategies that Chinese doctors often used online. In addition, several strategies were found to enhance patient satisfaction including information provision, making diagnosis, information appraisal, emotion expression, emotion recognition and support, in-depth discussion of medical treatments, providing coping strategies, and enabling self-management.

Conclusion

Chinese patients may have developed multiple needs, which they expect to fulfill through their interactions with doctors. Technological affordances of online medical platforms may pressure doctors to adapt their communication strategies to patients' needs. Our findings develop the PEO model from the perspective of patient-provider communication strategies and add a perspective centering on patients' needs to the scholarship on patient satisfaction. In addition, these results provide practical implications on how to improve patient-provider communication online.

Impact of COVID-19, cancer survivorship and patient-provider communication on mental health in the US Difference-In-Difference

Poor mental health has been found to be more prevalent among those with cancer and is considered a public health crisis since COVID-19. This study assessed the impact of COVID-19 and cancer survivorship on mental health and investigated factors, including online patient-provider communications (OPPC; email/internet/tablet/smartphone), associated with poor mental health prior to and during the early COVID-19. Nationally representative Health Information National Trends Survey data during 2017-2020 (n = 15,871) was used. While the prevalence of poor mental health was high (40-42%), Difference-In-Difference analyses revealed that cancer survivorship and COVID-19 were not associated with poor mental health. However, individuals that used OPPC had 40% higher odds of poor mental health. Low socioeconomic status (low education/income), younger age (18-64 years), and female birth gender were also associated with poor mental health. Findings highlight the persistence of long-standing mental health inequities and identify that OPPC users might be those who need mental health support.

How Online Patient-Provider Communication Impacts Quality of Life: Examining the Role of Patient-Centered Care and Health Competence

The question of how patient-provider communication affects health outcomes has been a longstanding concern for health communication scholarship and practice. As patient-provider communication becomes increasingly mediated by digital technologies, much research has sought to compare online patient-provider communication (OPPC) with that conducted in-person, weighing its relative merits against its costs and barriers. This line of inquiry has mostly focused on the comparative benefits of OPPC for service delivery with little attempt to link these benefits to the wider health implications of OPPC. Consequently, the mechanisms that explain the impacts of OPPC on patients' overall wellbeing have been underexamined. Through a survey of 681 participants in China, this study examined the direct and indirect pathways between OPPC and quality of life (i.e., sleep, exercise, social activities, and psychological wellbeing). Our results demonstrate statistically significant direct relationships between OPPC and the four quality-of-life constructs examined as well as the mediation effects of patient-centered care and health competence in these relationships. The findings call for greater attention to the longer-term contributions of OPPC in empowering patients, especially those who are underserved by the healthcare system.

Can Online Patient-Provider Communication Improve Emotional Well-Being? Examining the Roles of Social Presence and Patient Empowerment

China has long been suffering from the problem of having health care that is expensive and difficult to access. Online patient-provider communication (OPPC) can offer a viable channel to increase access to care. However, through what underlying mechanisms OPPC can be associated with better health outcome is under-researched. To fill this research gap, this study investigated OPPC usage in China and identified psychological processes linking OPPC to emotional well-being. With two-wave panel surveys conducted in China, we found that mobile health app, social media, and health information service website were three common platforms for OPPC, followed by patient portal, whereas e-mail was used least frequently. Overall, OPPC did not have any direct effect on emotional well-being. Instead, OPPC first increased users' perceived social presence of providers in OPPC, which in turn triggered sense of patient empowerment, which finally enhanced emotional well-being.

Ehealth and lifestyle change: The mediating roles of social support and patient empowerment

Objectives

The purpose of this study was to investigate the impact of eHealth, the use of information and communications technologies to improve or enable health and health care, on lifestyle behaviors through social support and patient empowerment as serial mediators.

Methods

We conducted an anonymous online survey of 29 items in October 2019 to assess Chinese people's eHealth activities (i.e. engaging in online health-related activities), social support (including emotional and instrumental support) and patient empowerment, for a lifestyle change. A total of 681 respondents aged 18 or above (49.9% males) with an average age of 30.8 completed the survey.

Results

Social support (including emotional and instrumental support) and patient empowerment were found to be salient mediators between eHealth and lifestyle behaviors. Specifically, engaging in eHealth activities can improve both perceived emotional support and instrumental support from care networks, of which both would increase patient empowerment, which subsequently prompted healthy lifestyle behaviors (β = .01, confidence interval (CI): [.003, .013] for emotional support as the first mediator; β < .01, CI: [.003, .010] for instrumental support as the first mediator). However, the results showed that engaging in eHealth activities was not directly associated with a healthy lifestyle (β = .01, p = .65).

Conclusions

Our findings suggest that eHealth is effective and useful to drive people into action to develop healthy lifestyle behaviors. Particularly, by providing multiple potential sources of social support, eHealth will promote both emotional support and instrumental support, which is vital to increase patient empowerment, and eventually leads to healthy lifestyle behaviors.

Patient Expectation in China: Exploring Patient Satisfaction in Online and Offline Patient-Provider Communication

Introduction

Online patient-provider communication (OPPC) has become an alternative approach to seek medical advice and contact health professionals. However, its penetration rate remains low, and the underlying mechanisms of patient satisfaction with OPPC are underexamined. This study investigates the role of patient expectancy and the expectancy violation of patient-centered communication (PCC) in patient satisfaction in emerging OPPC scenarios by integrating the concepts of PCC and expectancy violation theory (EVT).

Method

An online survey was conducted in October 2019 among Chinese respondents who experienced OPPC and offline medical services.

Results

The 471 qualified participants reported high satisfaction with OPPC (mean [M] = 3.63, standard deviation [SD] = 0.81). However, patient satisfaction with OPPC was lower than that in offline medical encounters (M = 3.75, SD = 0.80), and patients suffered a higher expectancy violation of PCC in OPPC scenarios (M = 0.45, SD = 0.76) than in offline medical encounters (M = 0.27, SD = 0.69). Nevertheless, patients' satisfaction with OPPC significantly increased as the frequency of OPPC usage increased (β = 0.209, p < 0.001). This positive relationship was partially mediated by the decrease in the expectancy violation of PCC in OPPC scenarios.

Discussion

The study can contribute to increasing the adoption of OPPC and reducing the burden of offline medical resources.

Patient Activeness During Online Medical Consultation in China: Multilevel Analysis

Background

Online medical consultation is an important complementary approach to offline health care services. It not only increases patients’ accessibility to medical care, but also encourages patients to actively participate in consultation, which can result in higher shared decision making, patient satisfaction, and treatment adherence.

Objective

This study aims to explore multilevel factors that influence patient activeness in online medical consultations.

Methods

A data set comprising 40,505 patients from 300 physicians in 10 specialties was included for multilevel analysis. Patient activeness score (PAS) was calculated based on the frequency and the proportion of patient discourses to the total frequency of doctor-patient interactions. Intraclass correlation coefficients were calculated to identify between-group variations, and the final multilevel regression model included patient- and physician-level factors.

Results

Patients were not equally active in online medical consultations, with PASs varying from 0 to 125.73. Patient characteristics, consultation behavioral attributes, and physician professional characteristics constitute 3 dimensions that are associated with patient activeness. Specifically, young and female patients participated more actively. Patients’ waiting times online (β=–.17; P<.001) for physician responses were negatively correlated with activeness, whereas patients’ initiation of conversation (β=.83; P<.001) and patient consultation cost (β=.52; P<.001) in online medical consultation were positively correlated. Physicians’ online consultation volumes (β=–.10; P=.01) were negatively associated with patient activeness, whereas physician online consultation fee (β=.03; P=.01) was positively associated. The interaction effects between patient- and physician-level factors were also identified.

Conclusions

Patient activeness in online medical consultation requires more scholarly attention. Patient activeness is likely to be enhanced by reducing patients’ waiting times and encouraging patients’ initiation of conversation in online medical consultation. The findings have practical implications for patient-centered care and the improvement of online medical consultation services.

Clinical trial participation in America: The roles of eHealth engagement and patient-provider communication

Objective

Public participation in a clinical trial is the foundation of clinical research and the cornerstone for the discovery of new treatment and improving health outcomes. This study aims to examine how eHealth engagement, patient–provider communication, and clinical trial knowledge are associated with clinical trial participation in the United States.

Methods

Data were drawn from the Health Information National Trends Survey Iteration 5 Cycle 4 conducted in 2020. The sample included 3865 American adults aged 18 years and above. Path analysis using structural equation modeling and hierarchical linear regression was performed to examine the effects of eHealth engagement and patient–provider communication on clinical trial participation.

Results

About 5% of American adults have ever participated in a clinical trial. Younger adults, males, minorities, and people with lower education, less clinical trial knowledge, and less eHealth engagement were less likely to participate. After controlling for demographic variables, we found that more eHealth engagement led to a better knowledge of clinical trials, which was strongly associated with participation. Further, patient-centered communication did not directly lead to clinical trial participation; instead, it positively moderated the relationship between clinical trial knowledge and participation.

Conclusions

The national survey data indicate that American participation in clinical trials remains low and a significant disparity exists. Within the context of the eHealth movement, it is critical to implement targeted interventions to improve clinical trial knowledge, address the digital divide, and enhance patient-centered communication.

A holistic framework for patient experience: 5P model

Purpose

Hospitals have become competitive organizations striving to serve the needs of empowered consumers seeking positive experiences. As a result, the patient experience turns into a critical driver of performance for hospitals. Accordingly, the question “what are the critical dimensions for creating a well-designed patient experience?” has been drawing increasing attention from the industry and academia alike. This paper aims to contribute to the understanding of patient experience by using multiple source data obtained from experts and patients.

Design/methodology/approach

This study uses a qualitative research approach to examine the perspectives of both health-care experts and patients about the experience. A semi-structured interview series is conducted with health-care professionals, academicians, researchers, physicians and patients.

Findings

The results suggest a novel framework for the patient experience including five critical dimensions as follows: provider, physician, patient, personnel and periphery. This framework, 5Ps of patient experience, provides a holistic picture, which integrates the perspectives of patients, health-care providers and experts including scholars and researchers.

Practical implications

The 5P framework can be used by health-care professionals to better understand the driving factors of patient experience and to create a strategy to improve patient satisfaction.

Originality/value

To the best of the authors’ knowledge, the present study is the first qualitative study, which provides a holistic approach to patient experience independent from the branch and considers the perspectives of both health-care experts and patients.

Calls to Action (Mobilizing Information) on Cancer in Online News: Content Analysis

Background

The health belief model explains that individual intentions and motivation of health behaviors are mostly subject to external cues to action, such as from interpersonal communications and media consumptions. The concept of mobilizing information (MI) refers to a type of mediated information that could call individuals to carry out particular health actions. Different media channels, especially digital media outlets, play an essential role as a health educator to disseminate cancer health information and persuade and mobilize cancer prevention in the community. However, little is known about calls to action (or MI) in online cancer news, especially from Asian media outlets.

Objective

This study aimed at analyzing cancer news articles that contain MI and their news components on the selected Malaysian English and Chinese newspapers with online versions.

Methods

The Star Online and Sin Chew Online were selected for analysis because the two newspaper websites enjoy the highest circulation and readership in the English language and the Chinese language streams, respectively. Two bilingual coders searched the cancer news articles based on sampling keywords and then read and coded each news article accordingly. Five coding variables were conceptualized from previous studies (ie, cancer type, news source, news focus, cancer risk factors, and MI), and a good consistency using Cohen kappa was built between coders. Descriptive analysis was used to examine the frequency and percentage of each coding item; chi-square test (confidence level at 95%) was applied to analyze the differences between two newspaper websites, and the associations between variables and the presence of MI were examined through binary logistic regression.

Results

Among 841 analyzed news articles, 69.6% (585/841) presented MI. News distributions were unbalanced throughout the year in both English and Chinese newspaper websites; some months occupied peaks (ie, February and October), but cancer issues and MI for cancer prevention received minimal attention in other months. The news articles from The Star Online and Sin Chew Online were significantly different in several news components, such as the MI present rates (χ²=9.25, P=.003), providing different types of MI (interactive MI: χ²=12.08, P=.001), interviewing different news sources (government agency: χ²=12.05, P=.001), concerning different news focus (primary cancer prevention: χ²=10.98, P=.001), and mentioning different cancer risks (lifestyle risks: χ²=7.43, P=.007). Binary logistic regression results reported that online cancer news articles were more likely to provide MI when interviewing nongovernmental organizations, focusing on topics related to primary cancer prevention, and highlighting lifestyle risks (odds ratio [OR] 2.77, 95% CI 1.89-4.05; OR 97.70, 95% CI 46.97-203.24; OR 186.28; 95% CI 44.83-773.96; P=.001, respectively).

Conclusions

This study provided new understandings regarding MI in cancer news coverage. This could wake and trigger individuals’ preexisting attitudes and intentions on cancer prevention. Thus, health professionals, health journalists, and health campaign designers should concentrate on MI when distributing health information to the community.

The Communicative Ecology of Chinese Patients' Experiences with Health Care

Patient satisfaction and trust are important intermediate outcomes along pathways linking clinician-patient communication to improve well-being, but they are difficult to achieve in Chinese health care. Problematic physician-patient interactions, questionable health-care organizational practices, and media coverage of medical scandals may have contributed to this problem. Nevertheless, there isscant literature documenting reasons underlying dissatisfaction with Chinese health care. Using Street's ecological model of communication in medical encounters as a conceptual framework, this study explores how media and organizational factors affect Chinese patients' satisfaction and trust both directly and as mediated by the quality of patients' past communication experiences with clinicians. A survey was conducted among 257 Ob-gyn patients in a top-tier hospital in Sichuan, China. The results show that several organizational and media factors, along with patients' experiences with physician communication, predict patient satisfaction and trust. Perceptions of physician communication mediated some of the relationships between organizational and media factors with outcomes. Theoretical and practical implications are discussed, particularly with respect to improving health-care services in China.

The Relationship between Face-to-Face and Online Patient-Provider Communication: Examining the Moderating Roles of Patient Trust and Patient Satisfaction

Patient-provider communication is an important factor influencing patients' health-related outcomes. This study examined how the quality of face-to-face communication with providers is associated with their subsequent Internet use for patient-provider communication. With an analysis of two-wave panel data collected in China, results showed that face-to-face patient-provider communication had a positive and direct effect on online patient-provider communication at a later time point. In addition, patient trust and patient satisfaction both positively moderated the relationship between face-to-face and online patient-provider communication. The results of this study emphasized the important roles of patient-centered communication and patient-provider relationship in the process of eHealth and mHealth movement, particularly in the Chinese health care system.