title: Trusting Social Media as a Source of Health Information: Online Surveys Comparing the United States, Korea, and Hong Kong.
abstract: BACKGROUND
  The Internet has increasingly become a popular source of health information by connecting individuals with health content, experts, and support. More and more, individuals turn to social media and Internet sites to share health information and experiences. Although online health information seeking occurs worldwide, limited empirical studies exist examining cross-cultural differences in perceptions about user-generated, experience-based information compared to expertise-based information sources.
  
  
  OBJECTIVE
  To investigate if cultural variations exist in patterns of online health information seeking, specifically in perceptions of online health information sources. It was hypothesized that Koreans and Hongkongers, compared to Americans, would be more likely to trust and use experience-based knowledge shared in social Internet sites, such as social media and online support groups. Conversely, Americans, compared to Koreans and Hongkongers, would value expertise-based knowledge prepared and approved by doctors or professional health providers more.
  
  
  METHODS
  Survey questionnaires were developed in English first and then translated into Korean and Chinese. The back-translation method ensured the standardization of questions. Surveys were administered using a standardized recruitment strategy and data collection methods.
  
  
  RESULTS
  A total of 826 participants living in metropolitan areas from the United States (n=301), Korea (n=179), and Hong Kong (n=337) participated in the study. We found significant cultural differences in information processing preferences for online health information. A planned contrast test revealed that Koreans and Hongkongers showed more trust in experience-based health information sources (blogs: t451.50=11.21, P<.001; online support group: t455.71=9.30, P<.001; social networking sites [SNS]: t466.75=11.36, P<.001) and also reported using blogs (t515.31=6.67, P<.001) and SNS (t529.22=4.51, P<.001) more frequently than Americans. Americans showed a stronger preference for using expertise-based information sources (eg, WebMD and CDC) compared to Koreans and Hongkongers (t360.02=3.01, P=.003). Trust in expertise-based information sources was universal, demonstrating no cultural differences (Brown-Forsythe F2,654=1.82, P=.16). Culture also contributed significantly to differences in searching information on behalf of family members (t480.38=5.99, P<.001) as well as to the goals of information searching.
  
  
  CONCLUSIONS
  This research found significant cultural differences in information processing preferences for online health information. Further discussion is included regarding effective communication strategies in providing quality health information.
authors.affiliation: Gachon University, Seongnam, Gyeonggi Province, Republic Of Korea.
authors.forename: Hayeon
authors.identifier: http://orcid.org/0000-0001-5951-8507
authors.initials: H
authors.lastname: Song
authors.forename: Kikuko
authors.identifier: http://orcid.org/0000-0003-4991-3436
authors.initials: K
authors.lastname: Omori
authors.forename: Jihyun
authors.identifier: http://orcid.org/0000-0003-2476-610X
authors.initials: J
authors.lastname: Kim
authors.forename: Kelly E
authors.identifier: http://orcid.org/0000-0002-8420-9113
authors.initials: KE
authors.lastname: Tenzek
authors.forename: Jennifer
authors.identifier: http://orcid.org/0000-0003-3725-5587
authors.initials: J
authors.lastname: Morey Hawkins
authors.forename: Wan-Ying
authors.identifier: http://orcid.org/0000-0002-1512-1396
authors.initials: WY
authors.lastname: Lin
authors.forename: Yong-Chan
authors.identifier: http://orcid.org/0000-0003-4045-1028
authors.initials: YC
authors.lastname: Kim
authors.forename: Joo-Young
authors.identifier: http://orcid.org/0000-0002-0666-6271
authors.initials: JY
authors.lastname: Jung
mesh_terms: D000328:Adult; D054626:Consumer Health Information; D003431:Cross-Cultural Comparison; D003466:Cultural Characteristics; D005260:Female; D006723:Hong Kong; D006801:Humans; D057226:Information Seeking Behavior; D020407:Internet; D008297:Male; D010820:Physicians; D056910:Republic of Korea; D061108:Social Media / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D035502:Trust; D014481:United States; D055815:Young Adult
keywords: consumer behavior; consumer health information; culture; information sharing; medical informatics; social media; trust