Elizabeth Sillence

Trust and mistrust of online health sites

Do different design and information content factors influence trust and mistrust of online health sites? Fifteen women faced with a risky health decision were observed while searching the Internet for information and advice over four consecutive weeks. In some sessions their searches were unstructured, whilst in other sessions they were directed to review specific sites, chosen for their trust design elements. Content analysis of concurrent verbalisations and group discussion protocols provided support for a staged model wherein design appeal predicted rejection (mistrust) and credibility of information and personalisation of content predicted selection (trust) of advice sites.

A framework for understanding trust factors in web-based health advice

Trust is a key factor in consumer decisions about website engagement. Consumers will engage with sites they deem trustworthy and turn away from those they mistrust. In this paper, we present a framework for understanding trust factors in web-based health advice. The framework is derived from a staged model of trust and allows predictions to be made concerning user engagement with different health websites. The framework is then validated via a series of qualitative, longitudinal studies. In each study, genuine consumers searched online for information and advice concerning their specific health issue. They engaged in free searching and were directed towards sites previously reviewed using the framework. Thematic analysis of the group discussions provided support for the framework and for the staged model of trust wherein design appeal predicted rejection (mistrust) and credibility of information and personalization of content predicted selection (trust) of advice sites. The results are discussed in terms of the merits of the framework, its limitations and directions for future work.

Health Websites that people can trust - the case of hypertension

Traditionally health advice has been anchored in face-to-face settings but increasingly patients are using the Internet for their health advice needs. This means that patients are now offered inconsistent advice from a range of sources and must determine which sites to trust and which to reject. To understand how consumers make these choices, 13 participants diagnosed with hypertension took part in a longitudinal study in which they searched for information and advice relevant to their condition. A content analysis of the group discussions revealed support for a staged model of trust in which mistrust or rejection of Websites is based on design factors and trust or selection of Websites is based on content factors such as source credibility and personalization. Based on this model, a set of guidelines for developing trust in health Websites is proposed and key differences between face-to-face communication and web-based systems are discussed.

Perceived Threat and Corroboration: Key Factors That Improve a Predictive Model of Trust in Internet-based Health Information and Advice

Background How do people decide which sites to use when seeking health advice online? We can assume, from related work in e-commerce, that general design factors known to affect trust in the site are important, but in this paper we also address the impact of factors specific to the health domain. Objective The current study aimed to (1) assess the factorial structure of a general measure of Web trust, (2) model how the resultant factors predicted trust in, and readiness to act on, the advice found on health-related websites, and (3) test whether adding variables from social cognition models to capture elements of the response to threatening, online health-risk information enhanced the prediction of these outcomes. Methods Participants were asked to recall a site they had used to search for health-related information and to think of that site when answering an online questionnaire. The questionnaire consisted of a general Web trust questionnaire plus items assessing appraisals of the site, including threat appraisals, information checking, and corroboration. It was promoted on the hungersite.com website. The URL was distributed via Yahoo and local print media. We assessed the factorial structure of the measures using principal components analysis and modeled how well they predicted the outcome measures using structural equation modeling (SEM) with EQS software. Results We report an analysis of the responses of participants who searched for health advice for themselves (N = 561). Analysis of the general Web trust questionnaire revealed 4 factors: information quality, personalization, impartiality, and credible design. In the final SEM model, information quality and impartiality were direct predictors of trust. However, variables specific to eHealth (perceived threat, coping, and corroboration) added substantially to the ability of the model to predict variance in trust and readiness to act on advice on the site. The final model achieved a satisfactory fit: χ2 5 = 10.8 (P = .21), comparative fit index = .99, root mean square error of approximation = .052. The model accounted for 66% of the variance in trust and 49% of the variance in readiness to act on the advice. Conclusions Adding variables specific to eHealth enhanced the ability of a model of trust to predict trust and readiness to act on advice.

Integrated digital communities: combining web-based interaction with text messaging to develop a system for encouraging group communication and competition

Digital communities are often portrayed as operating entirely within the confines of a single technological domain, e.g. a group of people in a web-based chatroom. In this study an integrated approach to digital communities is explored. It is proposed that members of communities employ a range of digital technologies to support their activities and sense of community. This paper describes a study that develops a community using combined text messaging or Short Messaging Service (SMS) with web-based interaction. An application based on this specification is built in order to develop and support a digital community based around the 2002 World Cup. Participants interacted with the system during the soccer tournament, chatting with other members and taking part in competitions. They successfully integrated SMS with the website. Participants reported feeling like a cohesive group and showed increased interest in soccer and the World Cup.

Please advise : using the Internet for health and financial advice

The Internet is a popular source of information and advice especially within the fields of health and finance. Previous research has raised the issue of quality with respect to online information and has suggested differences between the way consumers and experts search for and appraise online information. However, many studies have asked students to act as ‘consumers’ or have relied upon artificial search tasks. This paper reports on research using ‘genuine’ consumers. The first study examines the trust markers held by genuine consumers in both the health and finance domains. The second study explores the perceptions of people who have actually used sources of online advice. The results indicate similarities between the trust markers of genuine consumers and experts. Trust markers differed between the two domains of health and finance and this was revealed in terms of the features of the sites visited. Genuine consumers may have different requirements and may be under different pressures compared to expert evaluators.

Editorial: The social implications of emerging technologies

Emerging technologies are at the forefront of technological innovation and research. In proposing this special issue, we linked the term emerging technologies with research areas such as intelligent, mobile and pervasive technology, as well as collaboration and communication technologies. Such technologies are characterised by their widespread use and presence. Their design has been focused on specific tasks such as communication, games and assistance. Their presence and use makes emerging technologies a major factor affecting peoples lives, making the social implications of emerging technologies important both in research and in practice. With this special issue of Interacting with Computers, we wish to provoke a thoughtful exploration of the social characteristics of emerging technologies. These characteristics may be inherent or attributed by users. An understanding of these social issues may also provide a rich source of design ideas and improvements. The increasing use of emerging technologies in our daily lives implies that the design decisions we make have a direct impact on our lives. Consequently, ideas for the improvement of our designs can have a direct beneficial impact on our lives. Intelligent, mobile and pervasive technology is emerging from laboratories and pervading everyday environments such as the home and the streets, entering the conscience of an ever-increasing part of the general public. Emerging technologies touch upon several important social issues, other than the often-cited issue of privacy. As researchers begin to identify and address these critical issues, we believe it is important to establish an open community dialogue to share these findings, create awareness regarding new research in these areas, and collaborate to work towards new challenges. This special issue acts as an initiator of such a dialogue.

The Effect of Credibility-Related Design Cues on Responses to a Web-Based Message About the Breast Cancer Risks From Alcohol: Randomized Controlled Trial

Background Internet sites typically contain visual design elements that are unrelated to the quality of the health information presented but that could influence credibility judgments and responses to health advice. To assess the effects of such design elements, or credibility cues, experimentally, we exposed women with different levels of weekly alcohol consumption to a website containing high quality but unpalatable information about a related health risk (breast cancer). The information was presented alongside either positive or negative credibility cues unrelated to information content. Objectives We explored four research questions: (1) Did the cues influence how the women engaged with the site? (2) Did they influence how the women responded cognitively and emotionally? (3) Did they influence whether the women subsequently acted on the advice? (4) Did the impact of the cues vary with how much alcohol the women reported drinking? Method A total of 85 women were randomly assigned to view one of two versions of a website containing the same high-quality content but different cues. One version had positive credibility cues (trustmarks), the other had negative ones (adverts, pharmaceutical sponsorship, and a donation button). Objective measures included visual attention (using eye-tracking equipment), time studying the material, and recall. Subjective measures included cognitive and affective responses and intention to change. Measures of subsequent behavior were taken 1 week later. Results First, the cues did not affect how long the women spent on the site or how long they spent reading the text. However, women in the negative cues condition spent more time looking at a donation button than those in the positive cues condition spent looking at a TRUSTe seal (β = −.43, P < .001) but less time looking at a logo (β = .43, P < .001) or at certain other features of the site. Those in the negative cues condition also recalled more site content (β = −.22, P = .048). Second, there were no effects of the cues on any of the measures of cognition, affect, vulnerability, or intentions. However, third, at follow-up, the positive cues had promoted greater alcohol reduction than the negative cues among those women who had previously reported drinking more heavily (β = −.22, P = .02). So, fourth, the responses to the cues did vary with how much alcohol the women typically drank. Conclusions Content-irrelevant images and logos can influence the behavioral response to quality health-risk information. These effects may be subtle, changing with time.

Children's understandings’ of obesity, a thematic analysis

Childhood obesity is a major concern in todays society. Research suggests the inclusion of the views and understandings of a target group facilitates strategies that have better efficacy. The objective of this study was to explore the concepts and themes that make up childrens understandings of the causes and consequences of obesity. Participants were selected from Reception (4–5 years old) and Year 6 (10–11 years old), and attended a school in an area of Sunderland, in North East England. Participants were separated according to age and gender, resulting in four focus groups, run across two sessions. A thematic analysis (Braun & Clarke, 2006) identified overarching themes evident across all groups, suggesting the key concepts that contribute to childrens understandings of obesity are “Knowledge through Education,” “Role Models,” “Fat is Bad,” and “Mixed Messages.” The implications of these findings and considerations of the methodology are discussed in full.

Communicating health decisions: an analysis of messages posted to online prostate cancer forums

Background  Experiential websites such as message forums and blogs allow Prostate Cancer (PCa) patients to communicate their health decisions to peers. The issues surrounding this form of indirect involvement in public health are little understood.