title: Characterizing the Processes for Navigating Internet Health Information Using Real-Time Observations: A Mixed-Methods Approach.
abstract: BACKGROUND
  Little is known about the processes people use to find health-related information on the Internet or the individual characteristics that shape selection of information-seeking approaches.
  
  
  OBJECTIVE
  Our aim was to describe the processes by which users navigate the Internet for information about a hypothetical acute illness and to identify individual characteristics predictive of their information-seeking strategies.
  
  
  METHODS
  Study participants were recruited from public settings and agencies. Interested individuals were screened for eligibility using an online questionnaire. Participants listened to one of two clinical scenarios—consistent with influenza or bacterial meningitis—and then conducted an Internet search. Screen-capture video software captured Internet search mouse clicks and keystrokes. Each step of the search was coded as hypothesis testing (etiology), evidence gathering (symptoms), or action/treatment seeking (behavior). The coded steps were used to form a step-by-step pattern of each participant's information-seeking process. A total of 78 Internet health information seekers ranging from 21-35 years of age and who experienced barriers to accessing health care services participated.
  
  
  RESULTS
  We identified 27 unique patterns of information seeking, which were grouped into four overarching classifications based on the number of steps taken during the search, whether a pattern consisted of developing a hypothesis and exploring symptoms before ending the search or searching an action/treatment, and whether a pattern ended with action/treatment seeking. Applying dual-processing theory, we categorized the four overarching pattern classifications as either System 1 (41%, 32/78), unconscious, rapid, automatic, and high capacity processing; or System 2 (59%, 46/78), conscious, slow, and deliberative processing. Using multivariate regression, we found that System 2 processing was associated with higher education and younger age.
  
  
  CONCLUSIONS
  We identified and classified two approaches to processing Internet health information. System 2 processing, a methodical approach, most resembles the strategies for information processing that have been found in other studies to be associated with higher-quality decisions. We conclude that the quality of Internet health-information seeking could be improved through consumer education on methodical Internet navigation strategies and the incorporation of decision aids into health information websites.
authors.affiliation: Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States. susan.perez@gmail.com.
authors.forename: Susan L
authors.identifier: http://orcid.org/0000-0002-3580-5197
authors.initials: SL
authors.lastname: Perez
authors.forename: Debora A
authors.identifier: http://orcid.org/0000-0001-8591-6875
authors.initials: DA
authors.lastname: Paterniti
authors.forename: Machelle
authors.identifier: http://orcid.org/0000-0003-1734-2755
authors.initials: M
authors.lastname: Wilson
authors.forename: Robert A
authors.identifier: http://orcid.org/0000-0001-5062-5082
authors.initials: RA
authors.lastname: Bell
authors.forename: Man Shan
authors.identifier: http://orcid.org/0000-0002-7801-3421
authors.initials: MS
authors.lastname: Chan
authors.forename: Chloe C
authors.identifier: http://orcid.org/0000-0001-8753-1370
authors.initials: CC
authors.lastname: Villareal
authors.forename: Hien Huy
authors.identifier: http://orcid.org/0000-0001-7726-9612
authors.initials: HH
authors.lastname: Nguyen
authors.forename: Richard L
authors.identifier: http://orcid.org/0000-0001-5575-529X
authors.initials: RL
authors.lastname: Kravitz
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D057226:Information Seeking Behavior; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Internet search; dual processing; health information; information seeking