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      Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review

      review-article
      , BSc (Hons), MSc, PhD 1 , , , BSc (Hons), PhD 2
      (Reviewer), (Reviewer), (Reviewer)
      Journal of Medical Internet Research
      JMIR Publications
      Internet, information seeking, physician-patient relations, health information

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          Abstract

          Background

          With online health information becoming increasingly popular among patients, concerns have been raised about the impact of patients’ Internet health information-seeking behavior on their relationship with physicians. Therefore, it is pertinent to understand the influence of online health information on the patient-physician relationship.

          Objective

          Our objective was to systematically review existing research on patients’ Internet health information seeking and its influence on the patient-physician relationship.

          Methods

          We systematically searched PubMed and key medical informatics, information systems, and communication science journals covering the period of 2000 to 2015. Empirical articles that were in English were included. We analyzed the content covering themes in 2 broad categories: factors affecting patients’ discussion of online findings during consultations and implications for the patient-physician relationship.

          Results

          We identified 18 articles that met the inclusion criteria and the quality requirement for the review. The articles revealed barriers, facilitators, and demographic factors that influence patients’ disclosure of online health information during consultations and the different mechanisms patients use to reveal these findings. Our review also showed the mechanisms in which online information could influence patients’ relationship with their physicians.

          Conclusions

          Results of this review contribute to the understanding of the patient-physician relationship of Internet-informed patients. Our main findings show that Internet health information seeking can improve the patient-physician relationship depending on whether the patient discusses the information with the physician and on their prior relationship. As patients have better access to health information through the Internet and expect to be more engaged in health decision making, traditional models of the patient-provider relationship and communication strategies must be revisited to adapt to this changing demographic.

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          Most cited references33

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          Four models of the physician-patient relationship.

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            Health information on the Internet: accessibility, quality, and readability in English and Spanish.

            Despite the substantial amount of health-related information available on the Internet, little is known about the accessibility, quality, and reading grade level of that health information. To evaluate health information on breast cancer, depression, obesity, and childhood asthma available through English- and Spanish-language search engines and Web sites. Three unique studies were performed from July 2000 through December 2000. Accessibility of 14 search engines was assessed using a structured search experiment. Quality of 25 health Web sites and content provided by 1 search engine was evaluated by 34 physicians using structured implicit review (interrater reliability >0.90). The reading grade level of text selected for structured implicit review was established using the Fry Readability Graph method. For the accessibility study, proportion of links leading to relevant content; for quality, coverage and accuracy of key clinical elements; and grade level reading formulas. Less than one quarter of the search engine's first pages of links led to relevant content (20% of English and 12% of Spanish). On average, 45% of the clinical elements on English- and 22% on Spanish-language Web sites were more than minimally covered and completely accurate and 24% of the clinical elements on English- and 53% on Spanish-language Web sites were not covered at all. All English and 86% of Spanish Web sites required high school level or greater reading ability. Accessing health information using search engines and simple search terms is not efficient. Coverage of key information on English- and Spanish-language Web sites is poor and inconsistent, although the accuracy of the information provided is generally good. High reading levels are required to comprehend Web-based health information.
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              Health Information on the Internet

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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                January 2017
                19 January 2017
                : 19
                : 1
                : e9
                Affiliations
                [1] 1Center for Health Informatics Department of Information Systems National University of Singapore SingaporeSingapore
                [2] 2SMU -TCS iCity lab Singapore Management University SingaporeSingapore
                Author notes
                Corresponding Author: Sharon Swee-Lin Tan tansl@ 123456comp.nus.edu.sg
                Author information
                http://orcid.org/0000-0001-5164-2749
                http://orcid.org/0000-0001-8195-0822
                Article
                v19i1e9
                10.2196/jmir.5729
                5290294
                28104579
                0755c59e-66eb-4dcb-8516-440cf8b230f1
                ©Sharon Swee-Lin Tan, Nadee Goonawardene. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 19.01.2017.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 9 March 2016
                : 27 June 2016
                : 26 October 2016
                : 23 November 2016
                Categories
                Review
                Review

                Medicine
                internet,information seeking,physician-patient relations,health information
                Medicine
                internet, information seeking, physician-patient relations, health information

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