title: Online health information, situational effects and health changes among e-patients in Israel: A 'push/pull' perspective.
abstract: BACKGROUND
  Access and use of online health information become increasingly important to health-oriented individual that may have implication for their health and wellness. The phenomenon of e-patients suggests that e-patients use the internet to increase health literacy and achieve health information about diagnosis, treatments, specialists and well-being before undergoing a health changes. Online health information may not 'fit' consultations with providers mainly when online source of information is trusted mainly when e-patients express lack of satisfaction with health-care providers. The strain between the two becomes evident when e-patients consider health changes.
  
  
  OBJECTIVE
  We examine health changes among e-patients. We assess the relationship between (a) trust in online health information and (b) satisfaction with health-care provider to predict two types of health changes: (a) well-being and (b) health-care changes. We also control for 'situational' effects including socio-economic and chronic illness variations.
  
  
  METHODS
  A telephone survey was conducted in 2010 in Israel among approximately 4000 individuals.
  
  
  METHODS
  Two-thousand individuals completed interviews (54% response rate). Seventy percentage were Internet users (n = 1371).
  
  
  METHODS
  Well-being health changes; health-care changes; satisfaction with institutional health-care provider; chronic illness: socio-economic: age; gender; marital status; education.
  
  
  METHODS
  Socio-economic and health status differences generate variations in use of online health information; trusting online health positively affects well-being - not health-care - changes but satisfaction with health-care provider positively improves the likelihood for health-care changes.
  
  
  RESULTS
  The results indicate that (a) e-patients use online health information to make well-being health changes - starting a diet or physical activity programme - but not health-care changes - in medication or in health-care provider - (b) satisfaction with institutional health provider has a significant effect on health-care decisions (c) chronically ill are not likely to use online health information.
  
  
  CONCLUSIONS
  E-patients' expectations from health-care institutional providers play a central role in initiating health changes. Access and use of online health information provide an alternative/additional channel for information when e-patients consider health changes and create a push/pull decision-making strain on both providers and recipients of health services. Health-care providers should address e-patients'concerns, mainly in cases of chronic illness concerns, and point to the boundaries of online health information. Traditional and novel sources of health information can increase health empowerment and better health care when communication channels between health providers and e-patients are comfortably verified in advance and agreed upon.
authors.affiliation: Department Of Human Services, University of Haifa, Haifa, Israel.
authors.forename: Rita
authors.initials: R
authors.lastname: Mano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D003142:Communication; D054626:Consumer Health Information; D003657:Decision Making; D005260:Female; D057220:Health Literacy; D006801:Humans; D020407:Internet; D007407:Interviews as Topic; D007557:Israel; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012923:Social Class; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: E-patients; online health information; push/pull theory; well-being and health-care health changes