Date of Degree
PhD (Doctor of Philosophy)
Jerry M. Suls
Prior research has indicated that laypeople construct mental representations of physical symptoms in order to attempt to understand illness (e.g., Leventhal, Safer, Panagis, 1983; Leventhal & Contrada, 1987; Lau, Bernard, & Hartman, 1989). These "illness representations" are influenced by prior experience with and prior knowledge about illness as well as efforts to seek additional information through social channels or media. More and more, the internet is a prominent source of health information, especially for older adults (aged 50 year and up). Yet, few studies have systematically examined how older adults search for health information online. Similarly, recent trends in healthcare such as health consumerism assume that patients will be more empowered if they have access to more information. However, little has been done to investigate whether patients, in fact, feel more empowered after acquiring online health information.
The current study examined the online health information seeking of older adults (N = 79) in order to determine the cognitive and diagnostic processes that older adults use to acquire information. Older adults read a vignette which depicted one of two common illnesses and then were asked to "think-aloud" while they attempted to diagnose the illness. Older adults then diagnosed the illness using either a traditional search engine (Google) or popular self-diagnosis tool (WebMD Symptom Checker), and answered questions about illness representations, cognitive effort, web interactivity, and feelings of empowerment after the search.
Quantitative results showed inconsistent change in illness representations. Plausible reasons for a lack of findings are discussed. Participants who used WebMD perceived greater cognitive effort while using the computer program than those who used Google, and participants who were inaccurate in their diagnosis perceived greater cognitive effort of diagnosing than those who were accurate. Accuracy was unrelated to perceived interactivity, age, or search method. Participants 50-64 years old found a new version of WebMD to be less interactive than Google. In contrast, participants 65 years or older perceived no difference in interactivity depending upon search method. In terms of empowerment, participants who used Google perceived greater choice than WebMD. There were no differences in feelings of competence depending upon search method.
Qualitative results showed that participants spent the majority of time navigating the computer and processing health information. Most participants diagnosed the illness by eliminating diseases whose symptoms did not match the symptoms of the illness vignette. Participants tended to visit commercial health websites such as Everyday Health and begin their information search by typing a vignette symptom into the search bar. Participants who were 65 years or older were less confident about their diagnosis than 50-64 year old participants. Finally, participants who used Google to diagnose were more likely to comment about the credibility of the information found when compared to those who used WebMD.
The current study found no change in illness representations after an online information search. However, this produces questions as to the amount of time in which the layperson constructs his/her illness representation. In addition, few differences in interactivity, accuracy, or empowerment were found between an online health information search conducted with a search engine as compared to a self-diagnosis tool. However, individual differences suggest that different age cohorts may prefer information to be presented in different ways which could influence web design. Further studies in human-computer interaction and health cognition may be able to answer the questions that arose.
Copyright 2012 Tana Luger
Luger, Tana Marie. "Older adults' online health information-seeking and diagnostic reasoning: a mixed methods investigation." dissertation, University of Iowa, 2012.