Variations in trust in Dr Google when experiencing potential breast cancer symptoms: exploring motivations to seek health information online

"The Materials Didn't Really Seem to Apply to Me": A Focus-Group Study on Young Women's Needs and Perspectives on Breast Cancer Educational Material

Young women breast cancer survivors face unique challenges in navigating diagnosis and treatment information while also navigating their own life demands (i.e., fertility, childcare, careers). Special consideration to printed and online cancer educational materials distributed to young women should be evaluated for their suitability, but few studies have investigated the educational preferences and needs of young women cancer survivors. We sought to explore young women breast cancer survivors' needs and preferences regarding cancer educational material from diagnosis to survivorship. We used a qualitative design with convenience sampling of young women breast cancer survivors who completed active treatment at a medical center within the last 5 years to participate in semi-structured online focus groups from November 2020 to May 2021. Thirty-three young women (75.8% White, 12.1% Black, 12.1% other) participated in one of seven online focus groups, each lasting approximately 2 h. Four dominant themes emerged from the data: (1) initial interaction with online materials; (2) reasons for seeking printed and online materials; (3) disconnection of visuals; and (4) recommendations. Our findings revealed that young women were initially hesitant to seek online information, but later sought printed and online information after specific endorsement of materials. Current breast cancer materials lack content specific to young women's needs (i.e., reconstruction options), and graphics have little age and racial diversity. Oncology nurses may consider novel methods of education delivery, such as short videos to be shared easily on social media for specific content like scarring results and reconstruction options.

Readability of online health information pertaining to migraine and headache in the UK

An estimated 46% of the worldwide adult population live with an active headache disorder, and it is thought that there is a proportion of headache and migraine sufferers who do not attend for medical care, instead choosing to manage their symptoms at home. The internet continues to act as a source of online health information for self-management, however, it is important that this information can be understood by the user. Research indicates that most health information online is written at a level too difficult for much of the UK population to understand. The aim of this study was to investigate the readability of online health information pertaining to headache and migraine for a UK-based internet user accessing the top four search engines. Searches for ‘headache’ and ‘migraine’ were performed on each search engine and results from the first page were selected for analysis. Five validated readability tests were used to analyse readability; Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index and Simple Measure of Gobbledygook Index. We found that the majority of online health information about migraine and headache is too difficult for the UK adult population to read. Findings highlight work is required to ensure that information from a wider variety of sources is easier to comprehend for much of the population in order for individuals to make informed decisions about health seeking and self-management of headache and migraine. Health information providers should weave readability analysis into their content design process, incorporating shorter sentences and simpler words in their description of conditions and treatment.

Digital mediation of candidacy in maternity care: Managing boundaries between physiology and pathology

This paper brings together scholarship across sociology, media and communication, and human computer interaction to explore the intersection of digital health and the maternity care system. We draw on data (including interviews, focus groups, observations, and analyses of digital media content) from 19 studies involving over 400 women to explore women's experiences of using different forms of digital support such as the Internet, mobile technologies (apps and text messaging), social media, and remote monitoring devices in their reproductive journeys. We use a best fit approach to analysis, mapping our findings to the candidacy framework and notions of trajectory work to understand how women engage in digital health practices to negotiate boundaries between physiology and pathology and to enter dialogue with maternity services during conception, pregnancy and the postnatal period. We propose an integrated revised conceptual framework which explicates intersections between digital and care practices, and micro-level negotiations between women and professionals in the maternal health context. Our revised framework retains the dimensions of candidacy, but it introduces a precursor to the identification of candidacy in the form of 'understanding normality'. It identifies distinct forms of digital work (e.g. information work, navigation work, machine work) which operate across the candidacy dimensions that women (and partners at times) engage in to negotiate legitimacy when entering into encounters with the maternity care system. Operating conditions (norms around expert motherhood; neoliberal discourses around health optimisation, risk and responsibilisation) provide a broader macro-level context, influencing the micro-level dialogic processes between women and healthcare professionals. Our synthesis highlights digital mediation as a useful filter to understand care systems, distribution of lay/professional responsibilities, relational practices and the (dis)enablement of candidacy.

The use of single-pill combinations as first-line treatment for hypertension: translating guidelines into clinical practice

: The 2008 European Society of Cardiology/European Society of Hypertension guidelines recommend the first-line prescription of two antihypertensive drugs in single-pill combinations (SPCs), also known as fixed-dose combinations, for the treatment of most patients with hypertension. This recommendation is based on a large amount of data, which shows that first-line treatment with SPCs supports reaching blood pressure targets rapidly and reducing cardiovascular outcome risk while keeping the therapeutic strategies as simple as possible and fostering adherence and persistence. As this approach constitutes a big shift from the stepped-care approaches that have been dominant for many years, practicing physicians have expressed concerns about using SPCs as first-line agents. In this review, we will discuss the barriers to the uptake of this recommendation. We will also offer suggestions to reduce the impact of these barriers and address specific concerns that have been raised.

A Revised Model of Trust in Internet-Based Health Information and Advice: Cross-Sectional Questionnaire Study

BACKGROUND

The internet continues to offer new forms of support for health decision making. Government, charity, and commercial websites increasingly offer a platform for shared personal health experiences, and these are just some of the opportunities that have arisen in a largely unregulated arena. Understanding how people trust and act on this information has always been an important issue and remains so, particularly as the design practices of health websites continue to evolve and raise further concerns regarding their trustworthiness.

OBJECTIVE

The aim of this study was to identify the key factors influencing US and UK citizens' trust and intention to act on advice found on health websites and to understand the role of patient experiences.

METHODS

A total of 1123 users took part in an online survey (625 from the United States and 498 from the United Kingdom). They were asked to recall their previous visit to a health website. The online survey consisted of an updated general Web trust questionnaire to account for personal experiences plus questions assessing key factors associated with trust in health websites (information corroboration and coping perception) and intention to act. We performed principal component analysis (PCA), then explored the relationship between the factor structure and outcomes by testing the fit to the sampled data using structural equation modeling (SEM). We also explored the model fit across US and UK populations.

RESULTS

PCA of the general Web trust questionnaire revealed 4 trust factors: (1) personal experiences, (2) credibility and impartiality, (3) privacy, and (4) familiarity. In the final SEM model, trust was found to have a significant direct effect on intention to act (beta=.59; P<.001), and of the trust factors, only credibility and impartiality had a significant direct effect on trust (beta=.79; P<.001). The impact of personal experiences on trust was mediated through information corroboration (beta=.06; P=.04). Variables specific to electronic health (eHealth; information corroboration and coping) were found to substantially improve the model fit, and differences in information corroboration were found between US and UK samples. The final model accounting for all factors achieved a good fit (goodness-of-fit index [0.95], adjusted goodness-of-fit index [0.93], root mean square error of approximation [0.50], and comparative fit index [0.98]) and explained 65% of the variance in trust and 41% of the variance in intention to act.

CONCLUSIONS

Credibility and impartiality continue to be key predictors of trust in eHealth websites. Websites with patient experiences can positively influence trust but only if users first corroborate the information through other sources. The need for corroboration was weaker in the United Kingdom, where website familiarity reduced the need to check information elsewhere. These findings are discussed in relation to existing trust models, patient experiences, and health literacy.

Online Information-Seeking About Potential Breast Cancer Symptoms: Capturing Online Behavior With an Internet Browsing Tracking Tool

Background

People engage in health information-seeking online when experiencing unusual or unfamiliar bodily changes. It is not well understood how people consult the internet for health information after the onset of unfamiliar symptoms and before receiving a potential diagnosis and how online information-seeking can help people appraise their symptoms. This lack of evidence may be partly due to methodological limitations in capturing in real time the online information-seeking process.

Objective

We explored women’s symptom attribution and online health information-seeking in response to a hypothetical and unfamiliar breast change suggestive of cancer (nipple rash). We also aimed to establish the feasibility of capturing in real time the online information-seeking process with a tool designed to track participant online searches and visited websites, the Vizzata browser tracker.

Methods

An online survey was completed by 56 cancer-free women (mean age 60.34 [SD 7.73] years) responding to a scenario asking them to imagine noticing a red scaly rash on the nipple. Participants were asked to make symptom attributions when presented with the scenario (T1) and again after seeking information online (T2). The online tracking tool, embedded in the survey, was used to capture in real time participant search terms and accessed websites.

Results

The tracking tool captured the search terms and accessed websites of most of the participants (46/56, 82%). For the rest (10/56, 18%), there was evidence of engagement in online information-seeking (eg, medical terminology and cancer attribution at T2) despite their searching activity not being recorded. A total of 25 participants considered cancer as a potential cause for the nipple rash at T1, yet only one of these used cancer as a search term. Most participants (40/46, 87%) used rash-related search terms, particularly nipple rash and rash on nipple. The majority (41/46, 89%) accessed websites containing breast cancer information, with the National Health Service webpage “Paget disease of the nipple” being the most visited one. At T2, after engaging in the internet search task, more participants attributed the nipple rash to breast cancer than at T1 (37/46, 66% vs 25/46, 45%), although a small number of participants (6/46) changed from making a cancer attribution at T1 to a noncancer one at T2.

Conclusions

Making a cancer attribution for an unfamiliar breast change did not necessarily translate into cancer-termed searches. Equally, not all internet searches led to a cancer attribution. The findings suggest that online information-seeking may not necessarily help women who experience unfamiliar breast cancer symptoms understand their condition. Despite some technical issues, this study showed that it is feasible to use an online browser tracking tool to capture in real time information-seeking about unfamiliar symptoms.