title: Dr Google and the consumer: a qualitative study exploring the navigational needs and online health information-seeking behaviors of consumers with chronic health conditions.
abstract: BACKGROUND
  The abundance of health information available online provides consumers with greater access to information pertinent to the management of health conditions. This is particularly important given an increasing drive for consumer-focused health care models globally, especially in the management of chronic health conditions, and in recognition of challenges faced by lay consumers with finding, understanding, and acting on health information sourced online. There is a paucity of literature exploring the navigational needs of consumers with regards to accessing online health information. Further, existing interventions appear to be didactic in nature, and it is unclear whether such interventions appeal to consumers' needs.
  
  
  OBJECTIVE
  Our goal was to explore the navigational needs of consumers with chronic health conditions in finding online health information within the broader context of consumers' online health information-seeking behaviors. Potential barriers to online navigation were also identified.
  
  
  METHODS
  Semistructured interviews were conducted with adult consumers who reported using the Internet for health information and had at least one chronic health condition. Participants were recruited from nine metropolitan community pharmacies within Western Australia, as well as through various media channels. Interviews were audio-recorded, transcribed verbatim, and then imported into QSR NVivo 10. Two established approaches to thematic analysis were adopted. First, a data-driven approach was used to minimize potential bias in analysis and improve construct and criterion validity. A theory-driven approach was subsequently used to confirm themes identified by the former approach and to ensure identified themes were relevant to the objectives. Two levels of analysis were conducted for both data-driven and theory-driven approaches: manifest-level analysis, whereby face-value themes were identified, and latent-level analysis, whereby underlying concepts were identified.
  
  
  RESULTS
  We conducted 17 interviews, with data saturation achieved by the 14th interview. While we identified a broad range of online health information-seeking behaviors, most related to information discussed during consumer-health professional consultations such as looking for information about medication side effects. The barriers we identified included intrinsic barriers, such as limited eHealth literacy, and extrinsic barriers, such as the inconsistency of information between different online sources. The navigational needs of our participants were extrinsic in nature and included health professionals directing consumers to appropriate online resources and better filtering of online health information. Our participants' online health information-seeking behaviors, reported barriers, and navigational needs were underpinned by the themes of trust, patient activation, and relevance.
  
  
  CONCLUSIONS
  This study suggests that existing interventions aimed to assist consumers with navigating online health information may not be what consumers want or perceive they need. eHealth literacy and patient activation appear to be prevalent concepts in the context of consumers' online health information-seeking behaviors. Furthermore, the role for health professionals in guiding consumers to quality online health information is highlighted.
authors.affiliation: School of Pharmacy, Curtin University, Perth, Australia.
authors.forename: Kenneth
authors.identifier: http://orcid.org/0000-0003-3022-4868
authors.initials: K
authors.lastname: Lee
authors.forename: Kreshnik
authors.identifier: http://orcid.org/0000-0001-7652-6074
authors.initials: K
authors.lastname: Hoti
authors.forename: Jeffery David
authors.identifier: http://orcid.org/0000-0003-0040-4753
authors.initials: JD
authors.lastname: Hughes
authors.forename: Lynne
authors.identifier: http://orcid.org/0000-0002-0806-6691
authors.initials: L
authors.lastname: Emmerton
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D066275:Health Information Exchange; D006801:Humans; D057226:Information Seeking Behavior; D020407:Internet; D008297:Male; D008875:Middle Aged; D017216:Telemedicine
keywords: Internet; chronic disease; consumer health information; health information search; health seeking behavior; information needs; interview; online health information seeking; patients; qualitative research