From July 2018 to August 2018, the Research Center for Rural Health Services carried out a study to assess residents’ health care needs. Based on the assessment of socioeconomic development and geographic distribution and suggestions from experts [39], 4 counties and districts across China were purposely selected as the survey areas, including 2 districts in urban China (Xiling in central China, Futian in eastern China) and 2 counties in rural China (Dangyang in central China, Sinan in western China) [40].

A multistage stratified random sampling was implemented to select representative samples of the districts’ and counties’ populations. In the sample size calculation, the design effect was set at 2.5, and the allowable error at the significance level of .05; the chronic disease prevalence was 21.338% according to the 2013 National Health Service Survey [41], and thus the minimum sample size in each survey area was calculated to be 3584 individuals. Given that a family in China has an average of 2.9 members [41], at least 1235 families in every study site needed to be investigated. In the 2 counties (Dangyang and Sinan), 5 towns in each county were randomly selected according to the distance to the county hospitals. Meanwhile, 6 villages in each town were randomly selected according to the distance to the township hospitals. In the 2 districts (Xiling and Futian), 5 streets in each district were randomly selected according to the distance to the medical centers. To ensure that at least 248 families in each town or street were effectively interviewed, 1 other town or street in each county or district was selected as a backup in case of refusal, closed household, or removal of defective questionnaires. We resampled and surveyed until the final sample size met the estimated requirement. The surveyed families were systematically sampled in the rosters of residents from the village or street councils. Under the guidance of well-trained interviewers, face-to-face interviews were conducted, and self-administrated questionnaires were used on all the members of the sampled families. Finally, data from 15,126 respondents in 5547 families were collected in total: 3310 individuals in 1360 families in 30 villages in Dangyang, 3983 individuals in 1355 families in 30 villages in Sinan, 4386 individuals in 1513 families in 6 streets in Futian, and 3447 individuals in 1319 families in 5 streets in Xiling. A total of 12,646 individuals above 15 years of age needed to answer the questions related to OHIS, and 5354 respondents (5354/12,646, 42.34%) reported using the internet to seek health information. Among the online health information seekers, those who failed to provide information for all variables queried in this study were excluded, and 5149 individuals were finally included in the analysis.

Ethical approval was obtained from the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (#IORG0003571).

First, Pearson’s chi-square test was used to compare sociodemographic differences between infrequent and frequent online health information seekers. Second, descriptive analysis was applied to show the prevalence of different types of online health information. Finally, binary logistic regression was conducted on each type of online health information to identify the sociodemographic differences in searches for health information types, and the adjusted odds ratio (AOR) and 95% CI were reported. The significance level was set at a P value of .05.

Table 2 shows an overview of the main sociodemographic characteristics of the study population and differences in the frequency of OHIS. Online health information seekers comprised more females (2669/5149, 51.84), and most of them lived in urban China (3993/5149, 77.55%). Almost two-thirds (3318/5149, 64.44%) of respondents reported infrequently using the internet to seek health information. Among people who were frequent seekers of online health information, more than half (1015/1831, 55.43%) were female. The comparison between the 2 groups revealed that differences in terms of gender (P<.001), age (P=.01), marital status (P<.001), education level (P<.001), annual household income per capita (P<.001), possession of commercial insurance (P<.001), and reported illness in the past 12 months (P=.02) were statistically significant. In contrast, area (P=.12), employment (P=.79), types of primary health insurance (P=.57), and having at least 1 chronic disease (P=.14) were not significantly different. Compared with infrequent online health information seekers, frequent seekers were more likely to be females (infrequent: 1654/3318, 49.85%; frequent: 1015/1831, 55.43%), were older (over 60 years old; infrequent: 454/3318, 13.68%; frequent: 282/1831, 15.40%), were more likely to be married (infrequent: 2649/3318, 79.84%; frequent: 1537/1831, 83.94%), were better educated (bachelor’s or above; infrequent: 834/3318, 25.14%; frequent: 566/1831, 30.91%), earned a higher income (over RMB ¥50k [RMB ¥1=US $0.15641; frequent: 1139/3318, 34.33%; frequent: 710/1831, 34.78%), were more likely to have commercial health insurance (infrequent: 628/3318, 18.93%; frequent: 470/1831, 25.67%), and were more likely to have reported illness in the past 12 months (infrequent: 659/3318, 19.86%; frequent: 415/1831, 22.67%).

Respondents reported 1 or more different types of health information they sought online. A majority of the respondents (3654/5149, 70.79%) had used the internet to seek health science popularization information, which was followed in popularity by healthy behaviors (3567/5149, 69.28%), TCM, and medical concerns (1703/5149, 33.07%). The prevalence of the searches for the 4 types of online health information is shown in Table 3.

The results of the binary logistic regression models illustrated sociodemographic differences in seeking the 4 types of online health information (Table 4). Being male was significantly associated with a lower possibility of seeking healthy behaviors (AOR 0.69, 95% CI 0.61-0.78) and TCM (AOR 0.64, 95% CI 0.57-0.73). Compared with individuals aged between 15 and 45 years, middle-aged individuals were more likely to seek TCM (AOR 1.86, 95% CI 1.61-2.15) and health science popularization (AOR 1.20, 95% CI 1.02-1.40), while older adults were more likely to seek information for medical concerns (AOR 1.40, 95% CI 1.12-1.76) and TCM (AOR 2.16, 95% CI 1.72-2.70). Compared with single respondents, married respondents were more likely to seek TCM (AOR 1.22, 95% CI 1.03-1.44) and health science popularization (AOR 1.20, 95% CI 1.02-1.41) but were less likely to seek healthy behaviors (AOR 0.67, 95% CI 0.56-0.80). Living in urban China was associated with increased odds of seeking TCM (AOR 1.23, 95% CI 1.01-1.52). Higher education attainment was correlated with a higher possibility of seeking healthy behaviors (3-year college: AOR 1.56, 95% CI 1.26-1.95; bachelor’s or above: AOR 1.33, 95% CI 1.10-1.62), medical concerns (senior high school: AOR 1.19, 95% CI 1.01-1.39; bachelor’s or above: AOR 1.46, 95% CI 1.20-1.77), and health science popularization (bachelor’s or above: AOR 1.50, 95% CI 1.23-1.83). Lower annual household income per capita was associated with increased odds of seeking healthy behaviors (RMB ¥10k-30: AOR 1.21, 95% CI 1.02-1.44) but decreased odds of seeking TCM (<RMB ¥10k: AOR 0.70, 95% CI 0.54-0.91; RMB ¥10k-30k: AOR 0.76, 95% CI 0.64-0.89). Respondents with urban-rural resident basic medical insurance were less likely to seek health science popularization than those with urban employee basic medical insurance (AOR 0.86, 95% CI 0.74-1.00). Having commercial health insurance was associated with a higher possibility to seek healthy behaviors (AOR 1.55, 95% CI 1.32-1.83) and TCM (AOR 1.27, 95% CI 1.10-1.47) but a lower possibility to seek medical concerns (AOR 0.82, 95% CI 0.70-0.95) and health science popularization (AOR 0.83, 95% CI 0.71-0.96). Individuals who had at least 1 chronic disease were more likely to seek medical concerns (AOR 1.27, 95% CI 1.07-1.51) and TCM (AOR 1.26, 95% CI 1.06-1.49). Similarly, those who reported illness during the past 12 months were also more likely to seek medical concerns (AOR 1.41, 95% CI 1.21-1.65) and TCM (AOR 1.17, 95% CI 1.00-1.38).

In this population-based study, we examined the sociodemographic differences in frequency of OHIS and types of online health information sought among the general population in China. This study corroborated the findings of a great deal of previous work in that individuals who were female, better educated, and had a higher household income were positively associated with OHIS [17,18,20,23]. The differences in frequency of OHIS among socioeconomically defined groups implied that inequality in health communication might also exist in China, which was consistent with findings of a previous study from Hong Kong [29]. We also found that living areas had no significant difference between infrequent and frequent online health information seekers, while this difference might exist between seekers and nonseekers [20]. In addition, the sociodemographic characteristics included in the analysis were not consistently associated with the types of online health information sought among the Chinese population.

One unanticipated finding is that respondents who frequently sought online health information were more likely to be middle-aged or older adults. This result deviated from the bulk of previous studies, which showed that younger age groups preferred the internet as a source of health information [17,20,23]. Regardless of sources, however, individuals with older age are more likely to search for health information [4,29]. Moreover, a study from Hong Kong found that older adults were more frequently exposed to health information from instant messaging such as WeChat [42]. Given that our study participants were those who had already searched on the internet for health information, a possible reason for this discrepancy is that once older adults have obtained access to online health information, they are likely to seek it more frequently than are younger individuals, thus suggesting the strong demand for health information among middle-aged or older adults in China. However, additional research effort is needed to verify this hypothesis further. As the population ages in China, the health department of the government and other health organizations should take the internet into account as an effective resource to intervene with the older adults’ health behaviors. Given that digital health is not reaching all seniors equally and that this disparity probably results in differences in health outcomes [23], the skills and knowledge of older adults should be reinforced so that more of them can use and benefit from online health information. We also found that the married group had a higher proportion of frequent seekers of online health information, suggesting that married respondents might also seek health information for their family members. A study among German older adults found that internet users were more likely to be married or with a partner [46]. Another study revealed that middle-aged adults were most likely to use the internet to search for information about a condition of a loved one [47]. The association between marital status and the frequency of OHIS may coincide with the association between age and the frequency of OHIS, which may also mean that older people seek out health information for themselves as well as for their partners [47]. Therefore, meeting the health information needs of older adults (eg, information on medical concerns and TCM) is beneficial not only for themselves but also for their partners.

Health science popularization was the most searched for type of online health information among Chinese respondents, and medical concerns was the least searched for type of information. Conversely, earlier literature mostly reported that medical information was the most searched for type of online information [19,30]. This discrepancy may have several causes. On the one hand, the cultural differences between China and other countries, especially Western countries, might have played a role. In recent years, the National Health Commission of China has encouraged the dissemination of health science popularization information in various ways [45]. The increasing popularity of social media and the ever-growing number of official accounts of health science popularization might have attracted many Chinese netizens to follow such information. For instance, by comparing Americans and Hong Kongers, one study revealed that the latter were more likely to trust and use information from social websites [48]. On the other hand, only a minority of respondents in our study had a chronic disease (995/5149, 19.32%) or reported illness in the past 12 months (1074/5149, 20.86%), but they were found more likely to seek information about medical concerns. In addition, the results also showed that respondents over 60 years of age were more likely to seek information about medical concerns, but only 14.29% (736/5149) of the study participants were over 60 years old.

Consistent with previous studies, our study confirmed that people facing health challenges preferred medical information rather than information on healthy behaviors [10,32], which indicated that individuals with more health risks were more eager to improve their current health status. Therefore, people’s preferences for health information may be influenced by distinct motivations [49]. More research needs to be conducted to understand Chinese people’s motivation in searching for OHIS. Information on healthy behaviors was found to be more likely to be sought by female or better-educated respondents, which was broadly in line with previous studies [50-52]. Our study also found that single respondents were more likely to seek information on healthy behaviors. The sociodemographic differences in preferences for online health information highlight the importance of distinguishing online health information seekers when tailoring and presenting needed information to targeted users.

Information on TCM was more likely to attract attention from older adults, especially older women with chronic diseases. A cross-sectional study focused on older adults in Shanghai indicated that females were more likely to trust and use TCM [53]. Another study showed that having chronic lung disease was significantly associated with higher TCM practitioner utilization [54]. Indeed, having a chronic condition was identified as one of the main factors that induced people to use TCM in China [55]. As the significant factors found in our study were consistent with those in several previous studies, the preference for online health information about TCM might partly reflect the preference for the use of TCM. Our findings also showed that 37.5% of the respondents had sought TCM information, while a study investigating OHIS behavior of Chinese college students reported that only 15.6% sought TCM information online [44]. Given that TCM is widely accepted and used among the middle-aged and older Chinese population [55], along with the advantages of online health information mentioned before, we believe the provision of TCM-related information on the internet may promote the use of TCM and improve the management of chronic disease in China.

Our study has several limitations. First, the content about the motivation for OHIS (eg, for self-care, treating families, and improving lifestyles) and health information sources on the internet (eg, social media and professional websites) were not surveyed, thus resulting in fewer details on the OHIS behavior of Chinese internet users. Second, differences in online health information type classification made our results difficult to compare with those of previous studies. Finally, the research from which this study originated was implemented in 2018. The degree and diversity of internet use has grown since the beginning of the COVID-19 epidemic in 2020. As internet hospitals [56,57], health quick response codes, and antiepidemic science popularization online have been developed and used during the pandemic, the penetration rate of online health information users, especially online medical service users, continues to increase [33]. In addition, the status quo of OHIS in China needs to be further investigated in future research.

This study enriches the current research on the OHIS behavior of the Chinese population. Furthermore, it presents additional knowledge that providers of online health information, government health departments, and other organizations can use. The significant factors found in our study highlight the necessity of identifying the characteristics of the typical online health information users in China, especially age, gender, education level, marital status, and health status, when targeting and developing health interventions by offering health information on the internet. Those who provide health information online should be aware of the needs of specific population groups so that targeted strategies to promote health are presented appropriately.