Lu Xinyi, Zhang Runtong, Wu Wen, Shang Xiaopu, Liu Manlu
School of Economics and Management, Beijing Jiaotong University, Beijing, China.
Saunders College of Business, Rochester Institute of Technology, Rochester, NY, United States.
J Med Internet Res. 2018 Aug 17;20(8):e253. doi: 10.2196/jmir.9364.
The internet has become a major mean for acquiring health information; however, Web-based health information is of mixed quality and may markedly affect patients' health-related behavior and decisions. According to the social information processing theory, patients' trust in their physicians may potentially change due to patients' health-information-seeking behavior. Therefore, it is important to identify the relationship between internet health information and patient compliance from the perspective of trust.
The objective of our study was to investigate the effects of the quality and source of internet health information on patient compliance using an empirical study based on the social information processing theory and social exchange theory.
A Web-based survey involving 336 valid participants was conducted in China. The study included independent variables (internet health information quality and source of information), 2 mediators (cognition-based trust [CBT] and affect-based trust [ABT]), 1 dependent variable (patient compliance), and 3 control variables (gender, age, and job). All variables were measured using multiple-item scales from previously validated instruments, and confirmative factor analysis as well as structural equation modeling was used to test hypotheses.
The questionnaire response rate was 77.16% (375/486), validity rate was 89.6% (336/375), and reliability and validity were acceptable. We found that the quality and source of internet health information affect patient compliance through the mediation of CBT and ABT. In addition, internet health information quality has a stronger influence on patient compliance than the source of information. However, CBT does not have any direct effect on patient compliance, but it directly affects ABT and then indirectly impacts patient compliance. Therefore, the effect of ABT seems stronger than that of CBT. We found an unexpected, nonsignificant relationship between the source of internet health information and ABT.
From patients' perspective, internet health information quality plays a stronger role than its source in impacting their trust in physicians and the consequent compliance with physicians. Therefore, patient compliance can be improved by strengthening the management of internet health information quality. The study findings also suggest that physicians should focus on obtaining health information from health websites, thereby expanding their understanding of patients' Web-based health-information-seeking preferences, and enriching their knowledge structure to show their specialization and reliability in the communication with patients. In addition, the mutual demonstration of care and respect in the communication between physicians and patients is important in promoting patients' ABT in their physicians.
互联网已成为获取健康信息的主要途径；然而，基于网络的健康信息质量参差不齐，可能会显著影响患者与健康相关的行为和决策。根据社会信息处理理论，患者对医生的信任可能会因患者寻求健康信息的行为而发生潜在变化。因此，从信任的角度确定互联网健康信息与患者依从性之间的关系很重要。
我们研究的目的是基于社会信息处理理论和社会交换理论，通过实证研究探讨互联网健康信息的质量和来源对患者依从性的影响。
在中国进行了一项基于网络的调查，共有336名有效参与者。该研究包括自变量（互联网健康信息质量和信息来源）、2个中介变量（基于认知的信任[CBT]和基于情感的信任[ABT]）、1个因变量（患者依从性）和3个控制变量（性别、年龄和职业）。所有变量均使用先前验证过的工具中的多项目量表进行测量，并采用验证性因素分析和结构方程模型来检验假设。
问卷回复率为77.16%（375/486），有效率为89.6%（336/375），信效度均可接受。我们发现，互联网健康信息的质量和来源通过CBT和ABT的中介作用影响患者依从性。此外，互联网健康信息质量对患者依从性的影响比信息来源更强。然而，CBT对患者依从性没有直接影响，但它直接影响ABT，进而间接影响患者依从性。因此，ABT的影响似乎比CBT更强。我们发现互联网健康信息来源与ABT之间存在意外的、不显著的关系。
从患者的角度来看，互联网健康信息质量在影响他们对医生的信任以及随之而来的对医生的依从性方面，比其来源发挥着更强的作用。因此，通过加强对互联网健康信息质量的管理可以提高患者依从性。研究结果还表明，医生应专注于从健康网站获取健康信息，从而扩大对患者基于网络的健康信息寻求偏好的理解，并丰富自己的知识结构，以在与患者沟通中展现专业性和可靠性。此外，医患沟通中相互表达关心和尊重对于促进患者对医生的ABT很重要。
