Health Information Seeking
Definition
Health information seeking represents intentional, active efforts to obtain specific information above and beyond the normal patterns of media exposure and use of interpersonal sources (Atkin, 1973; Griffin, Dunwoody, & Neuwirth, 1999). It includes "any non-routine media use or interpersonal conversation about a specific health topic and thus includes behaviors such as viewing a special program about a health-related treatment, using a search engine to find information about a particular health topic on the Internet, and/or posing specific health-related questions to a friend, family member, or medical practitioner outside the normal flow of conversation" (Niederdeppe, Hornik, Kelly, et al., 2007, p. 155).
Health information seeking is distinguished from information scanning (e.g., Morris, Rooney, Wray, & Kreuter, 2009; Niederdeppe, et al., 2007), which is information acquisition from routine or habitual media use and interpersonal communication. Information scanning is seen as less active and less goal-directed than information seeking.
Recent research conceptualizes health information seeking both as a predictor and as an outcome variable. For example, health information seeking may foster therapeutic effects for those with cancer, such as increased knowledge about cancer, better coping, less stress, more social support, and appropriate changes in lifestyle (e.g., Shim, Kelly, & Hornik, 2006; van der Molen, 1999).
As an outcome variable, health information seeking can be impacted by demographics and individual differences, such as a person's information needs (Baker, 1995; Bennenbroek, Buunk, Van der Zee, & Grol, 2001; Boberg et al., 2003; Borgers et al., 1993; Cameron et al., 1994; Connell & Crawford, 1988; Ford, Coups, & Hay, 2006; Lock & Wilson, 2002), ethnicity (e.g., Kakai, Maskarinec, Shumay, Tatsumura, & Tasaki, 2003; Nguyen & Bellamy, 2006), and media preferences (e.g., James, James, Davies, Harvey, & Tweddle, 1999).
Czaja, Manfredi, and Price (2003) found increased information seeking among cancer patients was associated with patients who discussed information with their physicians.
Most often, health information seeking behaviors are associated with positive attitudes, knowledge, and behaviors. For example, Dutta-Bergman (2004) found consumers who seek medical information on the Internet were more likely to be health conscious, hold stronger health beliefs, and engage in health activities compared with consumers who did not search the Internet.
Maibach, Weber, Massett, et al. (2006), note consumers continue to receive the majority of their health information from traditional media and interpersonal sources (e.g., television, doctor, books, magazines, etc.), and certain consumers seek their health information exclusively from traditional sources (Gollop, 1997; Tu & Hargraves, 2003).
Yet, recent research on health information seeking frequently focuses on the Internet perhaps due to the availability of unprecedented, comprehensive consumer health informatics-based and tailored mobile health services. Some of this research focuses on the motivation to use consumer health informatics services provided by the National Institutes of Health (NIH), such as the Cancer Information Service (CIS) and the Center for Health Enhancement Systems Studies (CHESS), MedlinePlus.gov, as well as health apps for mobile devices.
Some of the research that specifically assesses consumer health information-seeking behavior on the Internet includes: Bass, Ruzek, Gordon, et al., 2006; Cline & Haynes, 2001; Dutta-Bergman, 2003, 2004; Gaie, 2006; and Silberg et al., 1997.
Health information seeking also is included in national overview data sets that assess broad consumer health information trends, such as the National Cancer Institute's Health Information National Trends (HINTS.cancer.gov) survey and the more frequently updated Pew Center for American Life's consumer health utilization research (http://pewinternet.org/Topics/Activities-and-Pursuits/Health.aspx?typeFilter=5). Both of these services provide downloadable data sets for research use, which encourages secondary analyses of their data.
Bass et. al. (2006) add health information seeking, whether through the Internet or traditional channels, generally reflects motivated behaviors. A health consumer's motivation may stem from a recent diagnosis or a new physical problem that fosters interest in self-care or caregiving. In turn, the role of health information seeking (among persons who are not health care providers) may be as a patient, a family member, a friend, or a caregiver. For example, Echlin & Rees (2002) assessed how persons in diverse life roles search for information about a personal cancer diagnosis or treatment decision (e.g., Echlin & Rees, 2002).
Suggested Measure
Unfortunately, there is no single, widely adopted measure of health information seeking. The most common approaches to measure health information seeking include:
- Using questions from the aforementioned Health Information National Trends Survey (HINTS)
- Recording key strokes by people using on-line information services
- A general single item measure
- A general multiple-item measure
- Measuring contacts to cancer information services.
The comparative value of each of these approaches is best determined by focusing on the objectives of a particular research project, the available technological expertise, and the project's budget.
Health Information National Trends Survey questions.
Niederdeppe, Frosch, and Hornik (2008) used two questions from the 2003 HINTS:
- Have you ever looked for information about cancer from any source?
Participants who said (if "yes", then asked):
- About how long ago was that?
For their study, Niederdeppe, Frosch, and Hornik focused on whether an individual sought information within a week of their interview (or study participation).
Ling, Klein, and Dang (2006) employed two items from the 2003 HINTS:
- Have you ever looked for cancer information from any source?
- Excluding your doctor or other health care provider, has someone else ever looked for information about cancer for you?
In a study that assessed correlates of awareness of CIS, other services at NIH as well as other scientific agencies, Squiers, Bright, Finney Rutten et al. (2006) used the following two questions to assess health information seeking, and treated each as single items.
- Have you ever looked for cancer information from any source?
- Excluding your doctor or other health care provider, has someone else ever looked for information about cancer for you?
Respondents who reported they had access to the internet (and who reported searching for health information) were asked how frequently they searched within the last 12 months. Squiers et al., added the question:
- Have you ever visited an Internet web site to learn specifically about cancer?
Shim, Kelly, & Hornik (2006) created an Information Seeking variable based on responses to the questions:
- Have you looked for information about cancer from any source?
- About how long ago was that?
Information seekers were categorized as such if respondents provided affirmative responses to both questions. Study respondents were categorized as a "nonseeker" if he/she answered one or both questions negatively.
2. Several studies measured health information seeking by capturing participants' use of CHESS by recording their Internet activities w/code name, date time, and URL of every web page request on the web server (e.g., Han, Hawkins, Shaw, Pingree, McTavish, and Gustafson, 2009; Han, Wise, Kim, et al., 2010; Lee & Hawkins, 2010). Some of the latter research also automatically recorded participants' keystrokes for CHESS use. In addition, some of the latter research conceptualized the degree of CHESS use (and health information seeking) as the number of days a participant accessed four different types of CHESS' services.
3. Dutta-Bergman (2005) measured "autonomous health information seeking," defined as a patient's willingness to seek additional health information beyond the doctor. This was measured by a single item:
I rely on a number of sources for health information, besides my doctor.
The item was measured on a 6-point scale ranging from 1 (definitely disagree) to 6 (definitely agree).
4. Maibach, Weber, Massett, et al. (2006) analyzed data from the Porter Novelli's HealthStyles 1999 and 2003 databases. They measured health information seeking but because they used these items within a larger cluster analysis, no composite index was computed and thus, no α was reported. The items were:
- I don't have time to bother learning a lot of health information
- I make a point to read/watch stories about health
- I don't pay attention to health information unless it's about a problem I have
- When sick, I try to get information about my disease
- I like to get health information from a variety of sources
- When I take medicine, I try to get as much information about benefits and side effects
- Before making a decision about my health, I find out everything I can about this issue
Each item was measured on a 1-5 Likert scale, where 1 = Strongly Disagree and 5 = Strongly Agree.
Stephens, Rimal, and Flora (2004) measured health information seeking with a three-item composite index:
They asked how frequently respondents read:
- Health and doctor's columns
- News articles on health
- Food and recipe information
Responses were coded on a 5-point scale ranging from "ignored" to "read all" and averaged into an index, = .78.
5. Finally, Waters, Sullivan, and Finney Rutten (2009) defined health information seeking as contacting the Cancer Information Service (NCI; toll-free information service) via telephone, or through LiveHelp (instant messaging service).
Reliability
Although only one of the aforementioned studies that measured health information seeking reported a reliability estimate (Stephens, Rimal, & Flora, 2004), the methods used in some of the other cited studies did not lend themselves to reliability measures. For example, two of the aforementioned measures were based on fairly direct observation of a specific behavior, either observation of Internet use through data collected by a web browser, or through calling or instant messaging a health information service.