El Sherif, Reem (2016). Exploring pitfalls of online consumer health information use and potential preventive strategies. McGill Family Medicine Studies Online, 11: e02.

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ABSTRACT

Background: There has been an exponential increase in the general population's usage of the Internet, and of information accessibility; the current demand for online consumer health information (OCHI) is unprecedented. In North America, more than 70% of adults have used the internet regularly to search for information in 2014, particularly OCHI. There are multiple studies on Internet access and usage, quality of information, and information needs. However, there is a limited number of studies that examine information use and subsequent outcomes. Only a few studied negative outcomes (pitfalls) associated with using OCHI, and none looked at preventing them. A recent systematic literature review, in which I participated, identified three main negative outcomes reported by consumers and physicians. This review was based on a conceptual framework of OCHI interactions and outcomes, and included studies in community-based primary health care setting. Building on the results of this review, my purpose in this investigation was to describe negative outcomes associated with OCHI use in primary care setting, and identify potential prevention strategies from consumers', health practitioners' and health librarians' perspectives.

Methodology and methods: I conducted a two-stage descriptive qualitative study. In the first stage, I recruited, through a social media survey, a purposeful sample of 19 key informants (OCHI users) who had experienced negative outcomes associated with OCHI. I conducted semi-structured interviews with them to understand their perspectives, and analysed transcribed verbatim thematically using a deductive and inductive approach to identify types of negative outcomes. The results also informed the creation of vignettes that were used in the next stage. In the second stage, I interviewed a convenient sample of 10 key informants: seven health practitioners (family physicians, nurses, and pharmacists), and three health librarians. With the support of the vignettes, I asked participants to elaborate on (a) their experience with patients who have used OCHI and experienced negative outcomes, and (b) what strategies they suggest to prevent these outcomes. Similar to stage 1 and building on stage 1 results, I transcribed interviews and analysed them thematically using a deductive and inductive approach.

Results: Themes and subthemes related to types of OCHI, motivations for searching OCHI, use of OCHI, and positive outcomes associated with the use of OCHI were identified from both stages and described. This evidence helped me properly identify and interpret the negative consumer outcomes reported in both stages of this study. I therefore found that negative outcomes of OCHI may occur at three levels: internal (such as increased worrying), interpersonal (such as a tension in the patient-physician relationship), and service-related (such as postponing a clinical encounter). Participants also proposed three types of strategies to prevent the occurrence of these negative outcomes, namely: providing consumers with reliable OCHI, educating consumers on how to assess OCHI websites, and helping consumers present and discuss the OCHI they find with a health professional in their social network or a librarian for instance.

Discussion and conclusion: Unlike other studies, I examined negative outcomes associated with using OCHI from four complementary perspectives: previous studies', OCHI consumers', primary care practitioners' and health librarians' perspectives. I conceptualized the results using a comprehensive and meaningful new construct: OCHI use-related tension. This construct has three dimensions (three inter-dependant levels): internal, interpersonal, and service-related tensions. This construct enriches our conceptual framework of OCHI interactions and outcomes. Future research can focus on the implementation and effectiveness of the proposed strategies, which might contribute to prevent and decrease these tensions.