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2025COM014.pdf
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18/11/2027
Doctoral thesis

Internet-informed patients in clinical care : how physician communication shapes health information behaviors

  • 2025
Health information seeking
Internet
Patient-physician communication
Patient-centered care
Empowerment
Literacy
English Online health information seeking (OHIS) has become increasingly prevalent across diverse populations over the past two decades. National surveys show substantial growth in Europe (from 32% in 2009 to 58% in 2024), the United States (from 51% in 2003 to 78% in 2022), and China (from 12% in 2010 to 48% in 2022). While this "democratization" of medical knowledge empowers patients, it also creates challenges related to information quality, overwhelm, and new tensions in patient-physician relationships. This dissertation examines how physician communication, particularly patient-centered communication (PCC), shapes patients' health information behaviors. The dissertation addresses four primary objectives through five interconnected studies: (1) systematically reviewing physician perspectives on internet-informed patients, (2) quantitatively examining associations between patient-centered communication and health information behaviors, (3) identifying mediating and moderating mechanisms in these relationships, and (4) investigating patient disclosure of internet-sourced information during medical encounters. It employs methodologies including systematic review and secondary survey studies of national datasets from China and four European countries, encompassing over 10,000 participants across multiple healthcare contexts. Study 1's systematic review of 22 empirical articles showed that the majority of physicians hold balanced views toward patient internet use, employing participative strategies (collaborating with patients) or defensive strategies (dismissing internet searching). Study 2 using Chinese survey data (N=3,090) demonstrated that physicians remain the most trusted health information source even during health crises. Studies 3 and 4, using the same dataset from four European countries, demonstrated that patient-centered communication is associated with both information avoidance and active online health information seeking: it is linked to reduced cancer information avoidance through enhanced trust and health literacy (Study 3, N=5,324) while being associated with increased use of professional online sources and decreased use of peer-dominant online sites through different uncertainty management strategies (Study 4, N=4,186). Study 5 further showed that patient-centered communication is positively associated with disclosure of online health findings across different patient profiles based on e-health literacy and empowerment levels (N=2,002 Chinese patients). This dissertation makes significant theoretical contributions by extending the Path Mediation Model to health information behaviors. The findings reveal that trust, health literacy development, empowerment, and uncertainty management serve as the mechanisms linking patient-physician communication to health information behaviors. The research also demonstrates mutual influence and reciprocity between patients and physicians, reflecting the ecological perspective in clinical communication. From a practical standpoint, this dissertation shows a fundamental shift from physicians as information gatekeepers to information curators who can guide patients through complex online health landscapes. It demonstrates that patient-centered communication can help patients navigate online health information while maintaining good clinical relationships. Therefore, healthcare systems should prioritize training physicians in patient-centered communication approaches for internet-informed patients, promoting collaborative partnerships that leverage both professional expertise and patient agency in today's digital era.
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  • English
Classification
Medicine
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Open access status
green
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https://n2t.net/ark:/12658/srd1333605
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