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      General practitioners’ challenges and strategies in dealing with Internet-related health anxieties—results of a qualitative study among primary care physicians in Germany Translated title: Herausforderungen für Allgemeinärzte und Strategien im Umgang mit internetbedingten Gesundheitsängsten – Ergebnisse einer qualitativen Studie bei Ärzten der Grundversorgung in Deutschland

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          Summary

          Time and again, it is discussed that in medical practices, the number of patients who develop health anxieties due to extensive health information searches on the Internet is increasing. The objective of this study is to explore and describe general practitioners’ experiences and attitudes towards cyberchondria patients as well as strategies to stabilize affected patients. Following a qualitative approach, oral personal semi-standardized interviews with general practitioners ( N = 38) in Rhineland-Palatinate, Germany, were conducted in 2019. In the course of a content analysis, one can see that most interviewees see the emergence of Internet-related health anxieties as an increasing problem in everyday care. Affected patients not only show marked levels of doubt and nervousness as well as hypersensitivity to their own state of health, but also low confidence in the physician. In addition to compliance-related difficulties, the high need for advice and the demand for further diagnostics are regarded as major problems. Various approaches were identified by which general practitioners respond to unsettled patients (more consultation time, recommendation of reputable websites, information double-checking, expanded history questionnaire, additional psychosocial training).

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          The online version of this article (10.1007/s10354-020-00777-8) contains supplementary material, which is available to authorized users.

          Translated abstract

          Immer wieder wird darüber diskutiert, dass in ärztlichen Praxen die Zahl jener Patienten steigt, die aufgrund ausufernder Online-Recherchen zu Gesundheits- und Krankheitsthemen Ängste um ihre Gesundheit entwickeln. Ziel der vorliegenden Studie ist es, die Erfahrungen und Einstellungen von Hausärzten im Hinblick auf Patienten mit „Cyberchondrie“ zu explorieren und Strategien zur Stabilisierung dieser Patientenklientel zu erfassen. Im Zuge eines qualitativen Ansatzes wurden mündlich-persönliche, halbstandardisierte Interviews mit Hausärzten ( n = 38) in Rheinland-Pfalz im Jahr 2019 durchgeführt. Die Inhaltsanalyse zeigt, dass die meisten Probanden das Aufkommen von internetassoziierten Gesundheitsängsten als zunehmendes Problem in der alltäglichen Versorgung sehen. Betroffene Patienten zeigen nicht nur ein erhebliches Ausmaß an Zweifeln und Nervosität sowie eine Hypersensitivität in Bezug auf den eigenen Gesundheitszustand, sondern zugleich ein geringes Vertrauen in den Arzt. Zugleich werden Compliance-Probleme, das ausgeprägte Bedürfnis nach patientenseitiger Rücksprache bzw. Diskussion und die Forderung nach weitergehender Diagnostik als erhebliche Probleme benannt. Verschiedene Ansätze wurden identifiziert, mit denen die Hausärzte versuchen, auf gesundheitsängstliche Patienten einzugehen und diese zu stabilisieren (mehr Beratungszeit, Empfehlung seriöser Internetseiten, Nachprüfung von recherchierten Informationen, Erweiterung des Anamnesefragebogens, psychosoziale Weiterbildung).

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          Cyberchondria: towards a better understanding of excessive health-related Internet use.

          Looking for information about symptoms and illnesses on the Internet is common and often serves useful purposes. However, a number of people who are overly distressed or anxious about their health perform excessive or repeated health-related searches on the Internet, only to become more distressed or frightened - a pattern defined here as cyberchondria. This behavior, which can also be construed as a form of reassurance seeking and occurs as a manifestation of health anxiety and hypochondriasis, is the focus of this article. The antecedents of cyberchondria, factors that maintain it and its consequences are examined conceptually and in light of the relatively little research that has been performed so far. Managing cyberchondria poses a challenge, and several approaches as part of the treatment of health anxiety and hypochondriasis are described. The article makes suggestions for further research on cyberchondria.
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            The Characteristics and Motivations of Online Health Information Seekers: Cross-Sectional Survey and Qualitative Interview Study

            Background Most households in the United Kingdom have Internet access, and health-related Internet use is increasing. The National Health Service (NHS) Direct website is the major UK provider of online health information. Objective Our objective was to identify the characteristics and motivations of online health information seekers accessing the NHS Direct website, and to examine the benefits and challenges of the health Internet. Methods We undertook an online questionnaire survey, offered to users of the NHS Direct website. A subsample of survey respondents participated in in-depth, semistructured, qualitative interviews by telephone or instant messaging/email. Questionnaire results were analyzed using chi-square statistics. Thematic coding with constant comparison was used for interview transcript analysis. Results In total 792 respondents completed some or all of the survey: 71.2% (534/750 with data available) were aged under 45 years, 67.4% (511/758) were female, and 37.7% (286/759) had university-level qualifications. They sought information for themselves (545/781, 69.8%), someone else (172/781, 22.0%), or both (64/781, 8.2%). Women were more likely than men to seek help for someone else or both themselves and someone else (168/509 vs 61/242, χ2 2 = 6.35, P = .04). Prior consultation with a health professional was reported by 44.9% (346/770), although this was less common in younger age groups (<36 years) (χ2 1 = 24.22, P < .001). Participants aged 16 to 75 years (n = 26, 20 female, 6 male) were recruited for interview by telephone (n = 23) and instant messaging/email (n = 3). Four major interview themes were identified: motivations for seeking help online; benefits of seeking help in this way and some of the challenges faced; strategies employed in navigating online health information provision and determining what information to use and to trust; and specific comments regarding the NHS Direct website service. Within the motivation category, four concepts emerged: the desire for reassurance; the desire for a second opinion to challenge other information; the desire for greater understanding to supplement other information; and perceived external barriers to accessing information through traditional sources. The benefits clustered around three theme areas: convenience, coverage, and anonymity. Various challenges were discussed but no prominent theme emerged. Navigating online health information and determining what to trust was regarded as a “common sense” activity, and brand recognition was important. Specific comments about NHS Direct included the perception that the online service was integrated with traditional service provision. Conclusions This study supports a model of evolutionary rather than revolutionary change in online health information use. Given increasing resource constraints, the health care community needs to seek ways of promoting efficient and appropriate health service use, and should aim to harness the potential benefits of the Internet, informed by an understanding of how and why people go online for health.
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              Orthopaedic Patient Information on the World Wide Web

              Patients increasingly use the Internet to research health-related issues. Internet content, unlike other forms of media, is not regulated. Although information accessed online can impact patients' opinions and expectations, there is limited information about the quality or readability of online orthopaedic information.
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                Author and article information

                Contributors
                julian.wangler@unimedizin-mainz.de
                michael.jansky@unimedizin-mainz.de
                Journal
                Wien Med Wochenschr
                Wien Med Wochenschr
                Wiener Medizinische Wochenschrift (1946)
                Springer Vienna (Vienna )
                0043-5341
                1563-258X
                7 August 2020
                7 August 2020
                2020
                : 170
                : 13
                : 329-339
                Affiliations
                GRID grid.410607.4, Centre for General and Geriatric Medicine, , University Medical Centre Mainz, ; Am Pulverturm 13, 55131 Mainz, Germany
                Article
                777
                10.1007/s10354-020-00777-8
                7518985
                32767159
                bbd79ede-2701-463b-8db7-dafce9429018
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 11 March 2020
                : 15 July 2020
                Funding
                Funded by: Universitätsmedizin der Johannes Gutenberg-Universität Mainz (8974)
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2020

                Medicine
                cyberchondria,health anxiety,health information,doctor–patient relationship,primary health care,general practitioner,cyberchondrie,gesundheitsangst,gesundheitsinformation,arzt-patient-verhältnis,primärversorgung,hausarzt

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