Objective With the rapid growth of the aging population, ensuring high perceived quality of care for older adults has become an increasingly critical issue. While telehealth and health-related social media have become important channels for older adults to access health information and services, little is known about their differential associations with perceived quality of care, and how various types of healthcare barriers are linked to their adoption and care outcomes. The aim of this study was to examine the roles of telehealth and health-related social media in the associations between healthcare barriers and perceived quality of care. Methods A secondary analysis was conducted using data from the Health Information National Trends Survey 7 (HINTS 7), focusing on adults aged 60 years and older (N = 1,278). Path analysis was employed to examine the relationships between variables. Results First, offline healthcare barriers (e.g., long wait times) and online information barriers (e.g., difficulty finding or understanding health information) were negatively associated with older adults’ perceived quality of care, whereas functional barriers (e.g., hearing, vision, or mobility limitations) and socioeconomic barriers (e.g., transportation difficulties) did not show any significant direct impact. Second, offline healthcare barriers were positively related to telehealth use, which was positively associated with perceived quality of care. Third, offline, functional, and socioeconomic barriers were positively associated with health-related social media use, which in turn was negatively correlated with perceived quality of care. Conclusion The results of this study clarify how different healthcare barriers relate to older adults’ perceived quality of care and show that telehealth can mitigate these barriers, whereas health-related social media is associated with lower perceived quality of care. Practice implications Health systems should institutionalize age-friendly telehealth, target subsidies and coverage to improve equitable access to older adults. Furthermore, addressing digital exclusion through health literacy programs is needed so that digital health technologies improve, rather than erode, older adults’ perceived quality of care.

Health information fact-checking has been identified as a potential solution to combat the spread of misinformation on social media. Therefore, it is crucial to understand what factors are associated with individuals' fact-checking behaviors on health (mis)information. This study examined how two types of social media involvement (active vs. passive) affected individuals' fact-checking behaviors. An online survey was conducted to collect the data and test the hypotheses. The results indicated that passive and active social media involvement were negatively and positively associated with health information fact-checking, respectively. Further analysis revealed that the association between the two ways of social media involvement and health information fact-checking was mediated by social media fatigue and moderated by self-perceived social media information literacy. These findings can help us to understand the complex effects of social media involvement on fact-checking behavior, and provide guidance to design campaigns aimed at promoting health information fact-checking.

In China, the traditional hierarchical doctor-patient relationship can hinder effective communication, especially in emotionally sensitive settings like cancer care. This study examined how patient-centered communication influences the health status of Chinese cancer patients and whether perceived burden and perceived support mediate this relationship. A cross-sectional survey was conducted among 271 cancer patients, yielding 217 valid responses. The findings show that patient-centered communication improves patients' health by alleviating their perceived burden and enhancing their perceived support. Given that many patients fear their illness and worry about burdening their families, these results highlight the importance of fostering more active communication and providing both informational and emotional support in clinical practice.

Promoting the usage of eHealth technologies has been considered an important way to cope with the challenges associated with aging. However, actual eHealth usage in older adults has remained low. Guided by the social ecological model, this study conducted an online survey to examine the associations between personal (perceived ease of use and perceived usefulness), interpersonal (bridging and bonding social capital), and cultural (collectivism) factors and older adults' eHealth use in Singapore. The findings indicated that perceived ease of use was positively associated with eHealth use, while perceived usefulness was not significantly related. Bridging social capital was positively associated with eHealth use, whereas bonding social capital showed no significant association. Furthermore, collectivist beliefs moderated the relationships between perceived ease of use, perceived usefulness, bridging social capital, and bonding social capital with eHealth use. This study presents an integrated theoretical framework that enhances the understanding of the correlates of eHealth use among older adults, and the findings offer practical insights for developing culturally sensitive strategies to promote digital health engagement in aging populations.

Health misinformation has long been recognized as detrimental to population health, especially during public health crises. However, the mechanisms through which health misinformation affects behavior remain underexplored. Drawing on the stimulus-organism-response (S-O-R) framework, this study investigated how misinformation exposure influences preventive health behaviors during the COVID-19 pandemic in China. Using a two-wave panel survey (Wave 1 in February 2020, Wave 2 in May 2020), we found that exposure to health misinformation via new media had a negative and direct effect on preventive behaviors. In contrast, exposure through traditional media and interpersonal sources increased perceived information overload, which reduced self-efficacy; lower self-efficacy, in turn, was associated with reduced engagement in COVID-19 preventive behaviors, demonstrating an indirect effect. Notably, misinformation exposure from new media did not significantly predict perceived information overload or have an indirect effect on preventive behavior. These findings offer important implications for health communication research and practice aimed at mitigating the harmful effects of health misinformation.

Enhancing eHealth literacy among older adults is recognized as a key strategy to increase their eHealth usage. However, the underlying mechanisms of this process remain underexplored. Drawing on the knowledge-attitude-practice (KAP) model and social norm theory, this study examined the mediating role of attitudes toward eHealth and the moderating roles of injunctive and descriptive norms of eHealth use in linking eHealth literacy to eHealth use among older adults. An online survey was conducted with 503 older adults in Singapore. The results revealed that eHealth literacy was positively associated with eHealth usage, with attitudes mediating this relationship. Additionally, descriptive norms positively moderated the relationship between eHealth literacy and attitudes toward eHealth, while injunctive norms positively moderated the relationship between attitudes toward eHealth and eHealth usage. Our conceptual model, which integrates both personal and interpersonal factors, provides valuable insights for health communication researchers and practitioners seeking to promote eHealth adoption in today's aging and digital society.

Social media has become an important avenue for learning. However, the mechanisms underlying social media use and its influence on knowledge are not clear. Based on the cognitive mediation model, this study explored the pathways through which social media use was linked to health knowledge, taking into account different information acquisition patterns (e.g., media attention vs. information discussion), information processing (e.g., elaboration), and information seeking experience. With a cross-sectional survey conducted in China (N = 1,350), this study found that paying attention to health information on social media had a direct and positive relationship with health knowledge. However, discussing such information was negatively associated with knowledge. Media attention also had a positive relationship with information discussion. Both media attention and information discussion were positively related to information elaboration, which in turn, had a positive association with health knowledge. Also, the poor quality of health information seeking experience weakened the relationship between social media use and elaborative processing. This study provides important implications for health communication research and practice in the digital era.

Objective: The aim of this study was to examine the effects of patient-centered communication, patient participation, and patient preference on patient trust in the context of China. Methods: A cross-sectional survey was conducted involving 217 cancer patients in China. Mediation and moderation analyses were performed to examine the relationships among the study variables. Results: First, patient-centered communication increased patient participation in decision-making, which, in turn, enhanced patient trust. Second, patient-centered communication did not have a direct effect on patient trust. Third, patient preference for a passive role in decision-making weakened the relationship between patient participation and patient trust. Conclusion: The results underscore the significant effect of facilitating patient participation in linking patientcentered communication to patient trust. However, medical communication should also respond to patients' preferred roles in the decision-making process. Practice implications: Doctors should provide patients with opportunities to ask questions and express their concerns. In addition, they should evaluate patients' preferred degree of involvement before inviting them to contribute so as to respect their preferences and values.

In the current media environment, some individuals have shifted from actively monitoring news toward passively waiting for the media to alert them about news to a certain extent, forming a "news-finds-me" (NFM) perception. Drawing on a cross-sectional survey (N = 906) of adults from the United States, this study investigates the relationship between the NFM perception and COVID-19 misperceptions. Findings demonstrated a positive association between NFM perception and misperceptions. Moreover, information avoidance mediated the relationship between NFM and misperception. Finally, need for cognition (NFC) was a significant moderator, such that among those with greater NFC, the indirect effect of NFM perception on misperceptions became weaker. Findings of this study can contribute to the literature of NFM perception in health contexts and provide useful guidelines for combating misinformation and misperceptions in the algorithm-generated information environment.

PurposeThe purpose of this review is to provide a conceptual framework of consumer engagement behavior in the value co-creation process of healthcare services, and further understand the current knowledge maps and advances.Design/methodology/approachSpecifically, the scoping review methodology is used to synthesize the extant findings. The authors first develop the inclusion/exclusion criteria to evaluate the source material for the review; then, the authors further conduct the literature refinement to select the final data sample. As such, the authors extract and analyze the information derived from these articles.FindingsThe authors found most related studies focus on exploring patients' engagement behavior in the value co-creation process, especially those with chronic disease; the findings also reveal that consumers are most likely to engage in the value co-creation process of healthcare services by seeking or sharing health information; also, consumers engagement behavior is mainly driven by individual, interactive, and technological factors; moreover, consumer engagement in the value co-creation of healthcare services are more likely to achieve positive health and behavioral outcomes.Originality/valueThe role of consumers has gradually shifted from that of passive recipients to that of active participants in the healthcare value co-creation process. Consumer engagement behavior is the key premise for the realization of healthcare value co-creation, and it has received increasing attention both academically and practically. By unearthing the conceptual framework of consumer engagement behavior in the value co-creation process of healthcare services, this study provides a systematic understanding and serves as a useful resource for future research and practice.

Meaning in life is essential for cancer survivors and may influence their coping behaviors and health. Extensive research has examined factors that predict meaning in life for cancer survivors. However, most of these studies focused on personal characteristics and reactions to a diagnosis but left the crucial role of communication underexamined. To fill this research gap, the current study conducted an empirical analysis of the US-based Health Information National Trends Survey 6 dataset (N = 900) and examined the underlying mechanisms through which patient-provider communication (PPC) and health-related social media use were related to cancer survivors' meaning in life. The results showed that both PPC and health-related social media use were positively associated with meaning in life. In addition, PPC was negatively associated with perceived social isolation, which in turn reduced meaning in life. Health-related social media use was positively related to perceived social isolation, which subsequently lowered meaning in life. Furthermore, health self-efficacy weakened the indirect pathway linking PPC and health-related social media use to meaning in life via perceived social isolation. The findings highlighted the constructive role of PPC and the dualistic role of health-related social media use in cancer survivors' meaning in life, as well as the risk-buffering role of health self-efficacy. We also discussed the important theoretical and practical implications of the findings.

Background Colorectal cancer is major public health concern in China. This study seeks to explore the role of online cancer information seeking in influencing colorectal cancer screening, by taking into account one’s coping appraisals (i.e., self-efficacy, response efficacy), threat appraisals (i.e., perceived severity, cancer worry) and cancer fatalism. Methods A cross-sectional survey was conducted with 730 participants in China recruited from a Chinese survey company’s online panels. Path analysis was performed to investigate the relationships between the key constructs. Results First, online cancer information seeking increased both coping appraisals and threat appraisals. Second, threat appraisal did not significantly influence cancer fatalism, but coping appraisal reduced cancer fatalism. Third, cancer fatalism had no effects on colorectal cancer screening. Lastly, online cancer information also had a direct and positive relationship with cancer screening. Conclusions This research emphasises the need for health organisations to offer timely cancer information to people, and educate them about the importance of cancer screening. Health authorities may also regulate online cancer information to ensure that the information is accurate and appropriate in improving people’s cancer prevention and cancer screening knowledge.

Social media have become an important platform for health promotion. Based on the Information-Community-Action Framework, we conducted a content analysis of 1,481 Facebook postings by Singapore's Health Promotion Board. Results showed that organizational information and health benefit information dissemination were positively associated with online audience engagement. Also, organization-audience interaction had a positive relationship with online audience engagement. In addition, messages that help build confidence for health behavior change increased online audience engagement. In addition to these main effects, organization-audience interaction also played a moderating role that strengthened the effects of information dissemination and action confidence building on online audience engagement. This study offers important theoretical contributions to the Information-Community-Action Framework and has practical implications for enhancing the effectiveness of health promotion in this digital era.

BackgroundReducing cancer fatalism is essential because of its detrimental impact on cancer-related preventive behaviors. However, little is known about factors influencing individuals’ cancer fatalism in China. ObjectiveWith a general basis of the extended parallel process model, this study aims to examine how distinct cancer-related mental conditions (risk perception and worry) and different information behaviors (information seeking vs avoidance) become associated with cancer fatalism, with an additional assessment of the moderating effect of information usefulness. MethodsData were drawn from the Health Information National Trends Survey in China, which was conducted in 2017 (N=2358). Structural equation modeling and bootstrapping methods were performed to test a moderated mediation model and hypothesized relationships. ResultsThe results showed that cancer risk perception and cancer worry were positively associated with online health information seeking. In addition, cancer worry was positively related to cancer information avoidance. Moreover, online health information seeking was found to reduce cancer fatalism, while cancer information avoidance was positively associated with cancer fatalism. The results also indicated that the perceived usefulness of cancer information moderated this dual-mediation pathway. ConclusionsThe national survey data indicate that cancer mental conditions should not be treated as homogeneous entities, given their varying functions and effects. Apart from disseminating useful cancer information to encourage individuals to adaptively cope with cancer threats, we advocate for health communication programs to reduce cancer information avoidance to alleviate fatalistic beliefs about cancer prevention.

目的:探讨北京市2 所医院癌症患者参与医疗决策对患者信任状况的影响,为增进患者信任、建立和谐的医患关系提供依据.方法:对北京市2 所三甲医院共 271 例癌症患者进行问卷调查,采用有调节的中介模型对调研数据进行分析.结果:癌症患者的患者信任状况与患者参与医疗决策的评分分别为(41.59±7.82)和(42.70±8.68),领悟社会支持与以患者为中心的沟通评分分别为(68.93±11.20)和(27.19±5.76);有调节的中介模型显示,领悟社会支持在癌症患者参与医疗决策与患者信任之间起中介作用(ab=0.06),以患者为中心的沟通在癌症患者参与医疗决策与领悟社会支持之间具有调节作用(B=0.03,t=2.02,P<0.05).结论:癌症患者参与医疗决策可以显著提高患者信任水平,促进和谐医患关系的建立,应鼓励并支持癌症患者参与临床决策.此外,医务人员应在诊疗过程中应秉持以患者为中心的沟通方式,帮助患者提高领悟社会支持水平.这有利于促进患者参与决策,并对患者信任具有积极作用.

Health misinformation is a serious problem that can cause confusion and risk-taking behaviors, undermining public health efforts. Fact-checking has been highlighted as an effective tool for coping with the challenge of misinformation. However, few studies have examined the factors influencing individuals’ health fact-checking behaviors. Using the comprehensive model of information seeking, we conducted a two-wave panel survey in China during the COVID-19 pandemic and explored the underlying process that might hinder COVID-19 fact-checking. The results showed that risk perception and worry about COVID-19 triggered a negative COVID-19 information-seeking experience, which reduced COVID-19 fact-checking. Moreover, the propensity to trust COVID-19 misinformation played a moderating role, such that negative information-seeking experience had a stronger negative effect on fact-checking behaviors for people with a greater propensity to trust misinformation. This study demonstrates the dark side of cognitive and affective responses to risks and health information-seeking experiences. The findings offer important implications for future health communication initiatives to effectively promote health fact-checking behaviors.

The human papillomavirus (HPV) vaccine is relatively novel to people in China. Social media is becoming an important channel for learning new health information. However, limited is known about what HPV vaccine information has been disseminated on social media, and how such online information is associated with health-related behaviors in China. Based on Longo et al.'s model of patient use of healthcare information for healthcare decision, and Longo's model of health information seeking behaviors, this study examined HPV vaccine-related information type and information acquisition pattern. Following the mixed-methods approach, we first crawled 67,773 postings about HPV vaccine on Weibo, the largest microblogging website in China, and performed topic modeling to identify HPV vaccine-related topics that are prevalent on Weibo. The results showed six major topics about HPV vaccine, namely policy, guidance information, advertising, scandals, personal experience sharing, and HPV risks. Second, we conducted an online survey (n = 1,982) to investigate how scanning, seeking, and discussing the six HPV vaccine topics identified from big data analytics can affect HPV vaccine knowledge, safety concern, and vaccination intention. We documented significant impacts of social media health communication on users' health knowledge, attitude and behavioral intention.

A growing body of research on medical communication indicates that nonverbal rapport (e.g., smiling, eye contact, closer proximity) is central to productive health care delivery. However, mechanisms integral to the process by which nonverbal rapport influences health improvement remain under-researched. This study breaks new grounds in proposing and testing mediation pathways that take into account organizational factors. We conducted a cross-sectional survey in a private hospital in Singapore among 417 patients to examine their communication with physicians and nurses. Results indicated that nonverbal rapport did not have a significant direct relationship with perceived health outcome in both the patient-physician dyad and the patient-nurse dyad. Instead, communication satisfaction and organizational identity completely mediated this relationship. In addition, respect positively moderated the relationship between nonverbal rapport and communication satisfaction in both dyads, while health literacy was not a significant moderator. The findings suggest that the organizational context should be considered in pathways research.

Cyberchondria is conceptualized as excessive online searches for medical information, which is typically accompanied by feelings of emotional distress or anxiety. While previous studies in this nascent area have identified various psychological predictors of cyberchondria, a relative dearth of research has explored the role of different online information sources in its development. Informed by the stimulus-organism-response (SOR) model and the literature on cyberchondria, this study proposes a theoretical framework to explain why people develop cyberchondria when seeking medical information via different online sources. Based on a three-wave panel survey (N = 654), our findings suggest that health information seeking via online search engines increases online information overload (fi = 0.11, p = .02), while health information seeking via social media platforms and health-specific websites increases online information trust (fi = 0.13, p = .005; fi = 0.25, p < .001). Additionally, online information overload is negatively related to online information trust (fi = -0.39, p < .001). Subsequently, both online information overload and online information trust trigger cyberchondria (fi = 0.73, p < .001; fi = 0.15, p < .001). This study can contribute to the literature by expanding and deepening our understanding of cyberchondria developmental trajectory as well as emphasizing the pivotal role of online information sources in this complicated and dynamic process.

eHealth use enables older adults to access and manage healthcare resources, and benefits their health; however, older adults' uptake of eHealth remains low across societies. Social influences such as descriptive norms may be of critical importance in promoting the elderly's usage of eHealth. Based on the Integrative Model of Behavioral Prediction, this study investigates how descriptive norms relate to eHealth use among the elderly in China and the United States. Analysis of the combined sample (N = 1,070) showed that descriptive norms were positively related to eHealth use. Also, descriptive norms were indirectly associated with eHealth use via injunctive norms, attitudes and self-efficacy. Moderated mediation analysis indicated that these direct and indirect relationships differed across the two countries. This study highlights the important role of descriptive norms in promoting older adults' eHealth use behavior and addresses potential country differences in how the elderly respond to descriptive norms. Several important theoretical and practical implications are also discussed.