Understanding Users’ Perception on the Trustworthiness of Online

Health Information

Shijuan Li, Beidi Yu, Jiexi Liu and Biting Huang

Department of Information Management, Peking University, Beijing, China

Keywords: Information Credibility, Information Trustworthiness, Information Literacy, Youth, Health Information

Seeking.

Abstract: The evaluation of online health information, i.e. its reliability, credibility, trustworthiness, etc., plays a

significant role in the users’ judging and health behaviour change process. Related works haven’t come to a

consensus on the framework of trust formation process. Nor much attention has been paid to one of the most

active groups of online information users, the youth. This study, from the young people’s perspective,

examines the perception and judgment on the trustworthiness towards online health information. To test the

design and reveal deficiencies of the study and procedure before time and resources are expended on large-

scale studies, a pilot study was designed and conducted. Then semi-structured interviews were employed

involving students from two groups: university freshman and the seniors respectively. The preliminary

results cover: the exploration of their health information seeking process, factor analysis towards

trustworthiness of online health information, the perceptions on HON measures and related health

information literacy.

1 INTRODUCTION

The assessment of online health information, i.e. its

reliability, credibility, trustworthiness, etc.,

influences greatly the users’ judging and health

behavior change process. Related works haven’t

come to a consensus on the framework of trust

formation process. It has been revealed that

credibility is a key impact factor of trust formation;

influencing users’ trust judgement and health

behaviour change eventually (Everard and Galletta

2005, Rowley et al., 2015). Other work indicated

that trust and credibility are two concepts overlapped,

since they share same sub-domains, i.e. brand,

content, usefulness, style, while considering

constructing an assessment framework (Fogg et al.,

2003, Rowley et al., 2015).

Nor much attention has been paid to one of the

most active groups of online information users, the

youth. Young people have been recognized as one of

the most active groups of the Internet users in China

(China Internet Network Information Center, 2016).

According to China Internet Network Information

Center (CNNIC), there were approximately 688

million Internet users in China by 2015, among

which 36.4% (around 224 million) were young

people (aged between 10 to 24). Though probably

they are supposed to have comprehensive surfing

skills and have extensive Internet experience, they

still have difficulty in evaluating the quality of

online information, especially health information

(Gray et al., 2005, Dobransky and Hargittai, 2012).

This study, from the young people’s perspective,

particularly examines the perception and judgment

towards trustworthiness of online health information,

which then will help to explore their health

information behaviour. The core questions are

designed include: If the youth are capable of judging

the quality of online health information? What are

their processes of trust formation towards online

health information? What factors influence

positively or negatively their acceptance and use of

online health information? The rest of the paper is

organized as follows: explanations of methods and

materials utilized during data collection and data

analysis process; preliminary analysis results from

the qualitative study, consisting of a pilot study and

semi-structured interviews; end with a discussion.

Li S., Yu B., Liu J. and Huang B.

Understanding Usersâ

Z Perception on the Trustworthiness of Online Health Information.

DOI: 10.5220/0006234404130417

In Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2017), pages 413-417

ISBN: 978-989-758-213-4

413

2 METHODS AND MATERIALS

The methods of the ongoing work are designed

including of a pilot study and semi-structured

interviews. Young people’s perception and judgment

towards the trustworthiness of online health

information are investigated utilizing searching

experiment and follow-up interviews. Volunteered

participants, aged between 18 to 24, were employed

in the Peking University (China) to take part in the

investigation. The participants were asked to firstly

attend 30 minutes long session to search for

information within a given health field. Each

participant should provide concurrent protocols as

they search the Internet for health information.

Meanwhile, a numerical scale, from one to ten, will

be provided to them to score the trustworthiness of

the searching results. Then a brief interview is

followed to explore the rational on how they allocate

scores for the trustworthiness of each result (Yu,

2016).

2.1 Related Measures

Evaluation tools are available to assess online health

information, and previous studies have used generic

tools, i.e., HON code, to examine the quality of web-

based healthcare information (Harland, 2007; Hsu

W-C, 2008; Kim, 1999). The Health On the Net

Foundation (HON) (www.healthonnet.org) promotes

and guides the deployment of useful and reliable

online health information, and its appropriate and

efficient use. The purpose of HON code is to protect

all from incorrect, indeed misleading medical and

health information. With this intention, HON

accredits web sites according to eight ethical

principles: 1) from which authority the information

is coming from; 2) what is the purpose of the site; 3)

the confidentiality policy; 4) the origin of the

sources used; 5) the justification about benefits and

performance of a specific treatment; 6) the

transparency of the authorship; 7) the transparency

of sponsorship as well as honesty in advertising; 8)

editorial policies. The user’s perceptions on those

selected measures are investigated in this study as

well.

2.2 Data Collection

The qualitative data are collected from both the pilot

study and interviews. A pilot study was conducted to

reveal deficiencies in the design of the study and

procedure before time and resources are expended

on large-scale studies. The participant approached

was a senior university student who was interviewed

about basic information about online health

information search and trustworthiness judgement.

Questions that were not answered as expected were

re-worded or re-scaled; time that taken to complete

the session was recorded to decide whether it is

reasonable; ambiguities in questions were identified

and clarified.

Then semi-structured interviews were conducted

involving students from two groups: university

freshman and the seniors respectively. The recorded

interviews were transcribed by one the research team

and then crosschecked by another member. The

preliminary results were analysed utilizing content-

based analysis that will be discussed in the next

section in greater details.

2.3 Data Analysis

The data collected from both the pilot study and the

interviews were recorded and transcribed with

permission from the participants for further analysis.

One concern is that of contamination of data.

This may arise from either where data from the pilot

study are included in the main results or where pilot

participants are included in the main study, but new

data are collected from these people (van Teijlingen

and Hundley, 2001). It is believed that

contamination is less of a concern in qualitative

research, where researchers often use some or all of

their pilot data as part of the main study. Some have

therefore argued that in qualitative approaches

separate pilot studies are not necessary (Holloway,

1997). Frankland and Bloor (Frankland and Bloor,

1999) indicated that piloting provides the qualitative

researcher with a “clear definition of the focus of the

study” which in turn helps the researcher to

concentrate data collection on a narrow spectrum of

projected analytical topics. Therefore, data from the

pilot study was included in the overall analysis.

The interpretation and analysis of the data

employed content-based thematic analysis that

involved classifying and coding the content into

themes. An explanation of the codebook used is as

shown in Table 1, including the code, theme and

their corresponding explanations. The main themes

formed from the data include: the health information

seeking process, perception on HON measures,

health information literacy, factor analysis on

trustworthiness etc.

HEALTHINF 2017 - 10th International Conference on Health Informatics

414

Table 1: Codebook.

Code Theme Ex

lanation

Credible

information

source

Health websites, hospital

websites, question and answer

communit

Credible

information

rovide

Large public hospitals, doctors

from famous hospitals

Credible

information

Disease symptoms, appointment

information, hospital and

department ranks, misunderstands

of info

mation

Not credible

information

Recommended medicine,

recommended thera

Not credible

facto

Active

acquisition

Hospitals and departments

Passive

uisition

Pushing articles

Information

trust formation

Information from authority

consistentl

3 PRELIMINARY RESULTS

Basing on both related theories and the previous

findings, the preliminary results from the qualitative

data are categorized into the following themes:

 Exploration of their health information seeking

process;

 Their perception on HON measures and related

health information literacy;

 Factor analysis towards trustworthiness of

online health information.

3.1 Health Information Seeking

Process

As shown in Figure 1, the participant actively seeks

for health information when a health related issue

occurred, or they passively received pushed

information from well-known information sources,

such as top websites or official organizations. The

take-for-granted trust on experts and large public

hospitals arguably affects young people’s

assessment of credibility of online health

information, and excludes other information sources

such as private sectors.

They tend to believe the health information

immediately as long as they are from large hospitals

with good reputation (i.e. Three grade hospital in

China), or the online health information were

provided by the physicians who have been working

in those large hospitals.

“The most credible website is hospital website.”

“Large hospitals hired these doctors have

verified their professionalism.”

“That information is provided by professional

doctors and it can’t impact my health.”

Figure 1: Health information seeking process.

3.2 Perceptions on HON Measures

Not very surprisingly, nearly all of the participants

have not heard of the HON code measures

previously due to their health information literacy

limitations. On the other hand, the HON code has

been well established in the western world prior its

translation into Chinese languages. Regarding to the

detailed eight measures that forming the HON’s

ethical principles; the authority, the purpose,

confidentiality and the frequency of the occurrence

of advertisement could have affected their

judgement and perception towards the online health

information’s credibility. Moreover, senior students

showed capability of more sophisticated information

literacy and willingness to explore complicated

measures for online health information.

“If I suffer from health problems which I can’t

solve with common sense, I must go to the hospital. I

don’t trust commercial recommendations.”

“Heavy advertisements are for profit only. They

may exaggerate the issues.”

Understanding Usersâ

Z Perception on the Trustworthiness of Online Health Information

415

3.3 Factor Analysis on Trustworthiness

Young people pay more attention to well-known

healthcare providers. They tend to neglect the

content or design of health information. Therefore,

their take-for-granted trust on the experts affects the

youth’s choices greatly.

Figure 2 and Figure 3 summarized the

subdomains of two important factors, “trust” and

“credibility”, from related studies.

“Trust/trustworthiness” and “credibility” have

been identified as two factors that affect each other,

which therefore confused the formation of

trustworthiness towards online health information

and the define of those two concepts. Nevertheless,

other factors, such as brand, content, verification,

style, design look, authority, expertise, real-world

feel, are identified as factors for the youth to decide

the trustworthiness towards online health

information.

Figure 2: Subdomains of “Trust”.

Figure 3: Subdomains of “credibility”.

“I read these articles carefully because they are

filtered by editors who should be responsible.”

“I use Internet to search what the disease is and

which hospital and department I should go to.

“When I browse the information I get from

search engine, all of them are consistent.”

4 DISCUSSION

The preliminary findings from our work is

summarized as following:

 The participants paid more attention to the

trustworthy information providers, i.e. leading

hospitals, doctors and web editors, which

contribute to the credibility of health

information.

 The take-for-granted trust on experts and large

public hospitals arguably affects young

people’s assessment of credibility of online

health information, and excludes other

information sources such as private sectors.

 The lack of provision of health information

from well-known organizations and

consumers’ deficiency in health information

literacy restricts the health information

seeking and utilizing behaviour.

Sillence et al. (2007) noted that the design and

content of information were major impact factors

within the dimension that users utilized to assess the

credibility of online health information. The reason

behind this difference between previous study and

ours will be investigated in future large-scale studies.

In addition, the result of pilot study indicated that

when conducting searching experiment, the task

should be set about a common symptom which

young people are more likely to suffer from. The

active acquisition and passive acquisition should

also be taken into consideration to augment the

research methodologies.

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