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The coronavirus pandemic (COVID-19) has also emerged as an infodemic, thereby worsening the harm of the pandemic. This situation has highlighted the need for a deeply rooted understanding of the health information–seeking behaviors (HISBs) of people.
The aim of this paper was to review and provide insight regarding methodologies and the construct of content in HISB surveys by answering the following research question: what are the characteristics of the measurement tools for assessing HISBs in nationally representative surveys around the world?
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used as the framework for this study. A data search was performed through 5 international and 2 Korean databases covering the years between 2008 and 2020. Initially, studies performed among nationally representative samples were included to discover HISB survey instruments. The methodologies of the studies using HISB surveys were analyzed. For content analysis, 2 researchers reached a consensus through discussion by scrutinizing the contents of each survey questionnaire.
A total of 13 survey tools from 8 countries were identified after a review of 2333 records from the search results. Five survey tools (Health Information National Trends Survey, Health Tracking Survey, Annenberg National Health Communication Survey, National Health Interview Survey, and Health Tracking Household Survey) from the United States, 2 instruments from Germany, and 1 tool from each of the countries of the European Union, France, Israel, Poland, South Korea, and Taiwan were identified. Telephone or web-based surveys were commonly used targeting the adult population (≥15 years of age). From the content analysis, the domains of the survey items were categorized as follows: information (information about health and patient medical records), channel (offline and online), and health (overall health, lifestyle, and cancer). All categories encompassed behavioral and attitude dimensions. A theoretical framework, that is, an information-channel-health structure for HISBs was proposed.
The results of our study can contribute to the development and implementation of the survey tools for HISB with integrated questionnaire items. This will help in understanding HISB trends in national health care.
The recent global pandemic of COVID-19, determined to be a public health emergency of international concern, has changed many aspects of people’s daily lives [
Health information–seeking behavior (HISB) is a comprehensive term that describes an individual’s behavior of seeking information, including the intentional collection and unintentional receipt of information [
The aim of this paper was to provide insights on the methodologies and the construct of content for HISB survey instruments based on nationally representative surveys.
The SPIDER (sample, phenomenon of interest, design, evaluation, and research type) format was used to formulate the research question for this review [
This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses [
To answer the research question, inclusion and exclusion criteria were established. Survey tools were included if they were full versions of the tools for HISBs and if they targeted nationally representative samples. However, tools were excluded when the full versions of the instruments were not accessible, not HISB-focused, nor used for a nationally representative sample.
As we seek in this study to discover the national survey tools for HISB, articles, reports, and related websites were searched for clues to detect those instruments. The data search was performed in 2 phases. The phase 1 search covering 2008 to 2017 was conducted between October 09, 2017 and November 13, 2017 through 7 databases: 5 international databases, namely, PubMed, CINAHL Complete (Ebsco), HaPI, PsycTESTS, and PsycINFO (Ebsco), and 2 Korean databases (RISS [Research Information Sharing Service] and DBpia). Phase 2 was performed between February 19, 2021 and March 25, 2021 to obtain recent literature covering 2017 to 2020 with the same search strategy (
PRISMA flow diagram of literature search and selection process. CDC: Centers for Disease Control and Prevention; HINTS: Health Information National Trends Survey; HISB: health information–seeking behavior; RISS: Research Information Sharing Service; WHO: World Health Organization.
Pilot searches were performed by the authors, and the final search strategy with the consultation of a librarian was utilized with MeSH terms (ie, information-seeking behavior) and free-text searching as well as the Boolean operators “OR” and “AND” (
Two authors (HC and GJ) initially reviewed the titles and abstracts of the papers and eliminated irrelevant documents. Then, HC and GJ scrutinized full-texts and filtered them according to the inclusion/exclusion criteria. As the purpose of the study was to seek nationally representative surveys of HISB, related websites were also accessed, such as that of The World Health Organization, which has the primary role of directing and coordinating international health, and Global Health Data Exchange [
We sought the characteristics of the selected instruments, including the name of the instrument, administrative institution, and funding sources, country, language, frequency of the survey, survey duration, sampling method, mode of survey administration, target population, total number of the population, and purpose of the measurement. In addition, the content of the survey instruments was scrutinized.
The aim of this study was to identify the measures used to analyze HISB in national surveys. Therefore, this review paper focuses on questionnaires in the national surveys on HISB and the risk of bias assessment is not applicable.
As this review is intended as content analysis, the authors thoroughly read the contents of the questionnaires of the selected HISB instruments. Themes emerged during this process as we used coding sheets with Excel and Word. The findings were provided through the process of reaching a consensus between the 2 authors on the coding sheets. Finally, the synthesized results were depicted in table and figure formats.
A total of 2333 papers were identified through 2 phases of the search process. From phase 1 of the search, 1476 papers were identified in the following academic databases: PubMed (n=529), CINAHL (n=202), HaPI (n=14), PsycTESTS (n=90), PsycINFO (n=246), RISS (n=288), and DBpia (n=107). Duplicates (n=151) were removed and 929 papers were eliminated. A total of 396 full-texts were reviewed and 157 documents were used for detecting 10 survey tools: (1) HINTS [
Phase 2 was performed to update the recent survey tools by using the same search strategy. As a result, 857 records were identified: PubMed (n=337), CINAHL (n=168), HaPI (n=2), PsycTESTS (n=20), PsycINFO (n=92), RISS (n=132), DBpia (n=105), and Google (n=1). Duplicates (n=105) were excluded, and 398 records were also removed after screening. The full texts of 354 papers were reviewed, and 70 records were used for detecting 7 survey tools. There were 4 duplicates of survey tools from phase 1. Therefore, 3 more survey tools, that is, Stiftung Gesundheitswissen (HINTS Germany) [
A total of 227 papers were related to the selected HISB instruments (
Brief characteristics of the instruments for measuring health information–seeking behaviors in nationally representative survey studies.
Country | Instrument | Survey version | Purpose of the measurement | Frequency | Target population | Total population in the survey (N) |
USA | Health Information National Trends Survey (HINTS) [ |
2019, HINTS 5, Cycle 3 | To investigate respondents’ access to and use of health information, including information technology to manage health and health information | Every few years (1-2 year cycle) | Civilian noninstitutionalized adults aged 18 years or older | 5247 |
USA | Health Tracking Survey [ |
2012 | To assess pursuit of health taking place within a widening network of both online and offline sources | Irregular | Adults aged 18 years or older | 3014 |
USA | Annenberg National Health Communication Survey [ |
2012 | To capture national trends related to health behavior and behavioral intentions to media exposure, health knowledge and beliefs, and policy preferences and beliefs | One-cycle survey | Adults aged 18 years or older | 3692 |
USA | National Health Interview Survey [ |
2020 | To monitor the health of the population through the collection and analysis of the data | Annual | Household | 33,138a |
USA | Health Tracking Household Survey [ |
2010 | To inform health care decision makers about changes in the health care system and the influence | Irregular (2-5 year period) | Household | 16,671 individuals (n=9165 Family Insurance Units) |
Europe | Flash Eurobarometer 404 (European citizen’s digital health literacy) [ |
2014 | To support increasing use of digital health care to help manage citizen’s own health | One-cycle survey | EU residents aged 15 years and older | 26,566 (28 EU countries) |
France | French Health Barometer (Baromètre santé) [ |
2017 | To gain a better understanding of French health knowledge, attitudes, beliefs, and behaviors | Annual | Adults aged 18-75 years | 15,635b |
Germany | Gesundheitsmonitor [ |
2015 | To assess health-related knowledge, attitudes, and behaviors | Annual | Adults aged 18-79 years | 1598 |
Germany | HINTS Germany [ |
2019 | To close the gap in important health-related information actions and systematical health records | Every few years (1-2 year cycle) | Adults aged 18-79 years | 2902 |
Israel | Not titled survey [ |
2014 | To measure eHealth literacy for others, including perceived outcome of internet use | One-cycle survey | Adult aged 21 years and older | 819 |
Poland | eHealth Consumer Trend Survey 2012c [ |
2012 | To show the trends in the perceptions and preferences of Polish citizens regarding internet use and factors affecting their usage | Irregular | Adults aged 15-80+ years | 1000 |
South Korea | Survey of cancer and health-related information–seeking behavior for Koreans [ |
2018 | To capture national phenomena of cancer and health-related health information–seeking behavior of Koreans | One-cycle survey | Adults aged 18-65+ years | 1012 |
Taiwan | Taiwan Communication Survey [ |
2016 | To explore media use behaviors among the general public, including health, risk, and disaster communication | Annual | Adults aged 18 years and older | 2098 |
a2019 sample size was reported. Data and report for 2020 will be published in fall 2021.
bFrench Health Barometer: the survey questionnaires were changed according to the survey years. The 2017 version of the survey contains health information–seeking behavior and is included in this study.
ceHealth consumer trend survey of 2012 was modified from the eHealth Consumer Trends Survey (2007), which was conducted in Denmark, Germany, Greece, Latvia, Norway, Poland, and Portugal in the World Health Organization/European eHealth Consumer Trends project [
HISB surveys were found in 8 countries (
As the surveys focused on domestic people, official or national languages were used (
HISB surveys were administered by national, nonprofit, public institutions, or individual researchers (
The frequency of the surveys was found to be annual, every few years, one time, or irregular (
The most common approach has been randomization, in particular, sampling with random digit dialing and then administration through a computer-assisted telephone interview (
The range of this study is restricted to researching tools used with adults (
The purposes were similar among the measurements: to monitor the use of health information in accordance with the type of information technology such as online or offline (
The contents of the questionnaire items for each tool were thematically reviewed and categorized by 2 researchers (HC and GJ). The themes were then merged and synthesized through consensus. Thus, 57 themes were detected and divided into 3 domains (
Average percentage of theme occurrence in the domains.
Content analysis of 13 representative national health information–seeking tools.a
Domain, subdomain, dimension, theme | Theme occurrence (%) | Theme occurrence average percentage (SD) | Subdomain average percentage (SD) | Domain average percentage (SD) | |||||||||
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33.0 (14.9) | ||||||||||||
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44.9 (14.9) |
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26.9 (5.4) |
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Perceived ease of use | 30.8 |
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Perceived efficacy of seeking | 23.1 |
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53.8 (6.3) |
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Search experience (frequency) | 46.2 |
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Information source | 61.5 |
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Type of information contents | 53.8 |
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Purpose of search (for whom) | 53.8 |
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24.0 (6.4) |
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21.5 (6.4) |
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Perceived privacy and confidentiality risk | 23.1 |
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Perceived ease of use | 15.4 |
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Perceived usefulness | 23.1 |
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Intention to use | 15.4 |
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Preference to provide access to others | 30.8 |
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28.2 (4.4) |
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Access frequency | 30.8 |
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Type of information contents sought | 23.1 |
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Purpose of seeking a record | 30.8 |
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50.5 (18.2) | ||||||||||||
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50.5 (15.9) |
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41.0 (4.4) |
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Perceived credibility | 38.5 |
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Perceived ease of use | 38.5 |
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Satisfaction with service quality | 46.2 |
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57.7 (18.3) |
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Access frequency | 84.6 |
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Type of health service | 46.2 |
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Communication with health care provider | 46.2 |
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Health-related decision making | 53.8 |
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50.5 (19.7) |
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39.6 (15.0) |
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Perceived credibility | 53.8 |
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Perceived ease of use | 38.5 |
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Perceived usefulness | 53.8 |
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Perceived eHealth literacy (technology efficacy) | 53.8 |
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Satisfaction with web-based information | 15.4 |
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Perceived confidentiality risks | 30.8 |
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Intention to use | 30.8 |
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59.0 (19.2) |
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Access frequency | 92.3 |
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Type of information technology device | 61.5 |
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Health-related web and app (software use) | 46.2 |
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Web-based resource (governmental website, Wikipedia, etc) | 53.8 |
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Communication (consult) with health care provider | 76.9 |
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Communication with friends and others (social media, forum, etc) | 61.5 |
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Health-related decision making | 69.2 |
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Tracking/managing health state | 38.5 |
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Improvement of health knowledge | 30.8 |
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44.2 (20.6) | ||||||||||||
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53.8 (18.0) |
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34.6 (5.4) |
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Perceived health efficacy | 38.5 |
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Concerns and belief about health | 30.8 |
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59.3 (16.4) |
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General health state | 84.6 |
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Diseases diagnosed | 69.2 |
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Height | 61.5 |
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Weight | 61.5 |
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Mental health | 53.8 |
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Caregiving | 30.8 |
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Social support | 53.8 |
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32.7 (21.3) |
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15.4 (8.9) |
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Perception about nutrition | 7.7 |
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Perception about physical activity | 15.4 |
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Perception about alcohol | 23.1 |
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Perception about tobacco | 23.1 |
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50.0 (13.3) |
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Nutrition | 30.8 |
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Physical activity | 61.5 |
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Alcohol | 53.8 |
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Tobacco | 53.8 |
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46.2 (13.3) |
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Perception about cancer | 38.5 |
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50.0 (16.3) |
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Cancer check-up | 38.5 |
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Cancer diagnosed | 61.5 |
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aTotal average percentage of the themes=44.0 (SD 19.3), total average percentage of attitude themes=30.4 (SD 13.5), and total average percentage of behavior themes=53.8 (SD 16.9).
Three domains, namely, information, channel, and health (
Information is a health-related, content-focused domain sought by the individual. There are 2 subdomains (
Average percentage of theme occurrence in the subdomains.
Representative sample questionnaire items for health information–seeking behavior survey instruments.
Domain, subdomain, dimension, theme | Questionnaire items |
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Perceived ease of use | How much do you agree or disagree- it took a lot of effort to get the information you needed (HINTSa) | |||
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Perceived efficacy of seeking | How confident are you that you could get advice about health if you needed it (HINTS) | |||
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Seek experience | Have you ever looked for information about health or medical topics from any source? (HINTS) | |||
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Information source | Thinking about the last time you had a serious health issue, did you get information from (selection of the information source)? (HTSb) | |||
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Type of information contents | What type of health-related information did you look for? (Europe) | |||
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Purpose of search (whom for) | The most recent time you looked for information about health or medical topics, who was it for? (HINTS) | |||
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Perceived privacy and confidentiality risk | Have you ever kept information from your health care provider because you were concerned about the privacy or security of your medical record? (HINTS) | |||
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Perceived ease of use | How easy or difficult was it to understand the health information in your online medical record? (HINTS) | |||
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Perceived usefulness | In general, how useful is your online medical record for monitoring your health? (HINTS) | |||
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Intention to use | Was denken Sie heute, werden Sie sich Ihre medizinischen Daten und Unterlagen mit Hilfe der Karte zukünftig näher anschauen? (What do you think today, will you take a closer look at your medical data and documents with the help of the card in the future?) (Gesundheitsmonitor, Germany) | |||
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Preference to provide access to others | In order to get a quick and valid diagnosis, I am positive about giving internet access to my medical record to a doctor in another location or abroad (Poland) | |||
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Access frequency | Have you approached your family doctor, specialist, or other health professional(s) over the internet to read your health record? (Poland) | |||
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Type of information contents sought | 귀하의 온라인 의료 기록에 다음과 같은 의료 정보가 포함되어 있습니까? (Do any of your online medical records include the following types of medical information?) (survey of CHISBc) | |||
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Purpose of seeking a record | In the past 12 months, have you used your web-based medical record to…(look up test results, monitor your health, etc) (HINTS). | |||
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Perceived credibility | Do you believe health-related information from medical staff at medical centers or pharmacies? (Taiwan) | |||
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Perceived ease of use | How difficult is it to contact a doctor or other health care providers at this place after their regular hours in case of urgent medical needs-very difficult, somewhat difficult, not too difficult, or not at all difficult? (HTHS) | |||
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Satisfaction with service quality | How satisfied are you with the health care you received in the past 12 months? (NHISd) | |||
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Access frequency | How many times have you personally been to the doctor within the last 12 months (Europe) | |||
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Type of health service | What kind of place do you go to most often - a clinic, doctor's office, emergency room, or some other place? (NHIS) | |||
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Communication with health care provider | In the past 12 months, did health care provider talk with you about all of the different prescription medicines you are using, including medicines prescribed by other doctors? (HTHSe) | |||
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Health related decision making | The following questions are about your communication with all doctors, nurses, or other health professionals you saw during the past 12 months: did they involve you in decisions about your health care as much as you wanted (HINTS)? | |||
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Perceived credibility | Selon vous, l’information de santé que vous avez obtenue la dernière fois est-elle crédible? (In your opinion, is the health information credible you obtained the last time (on the internet?) (France) | |||
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Perceived ease of use | In general, how comfortable do you feel. (using computers, internet, etc) (ANHCSf) | |||
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Perceived usefulness | How useful was the health information you found online? (HTHS) | |||
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Perceived eHealth literacy | I know how to use the internet to answer my health questions (Israel) | |||
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Satisfaction with web-based information | Overall, how satisfied or not are you with the health-related information you found on the internet? (Europe) | |||
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Perceived confidentiality risks | There are different reasons for not approaching your family doctor, specialist, or other health professional(s) via the internet. Which reasons apply to you? (I worry about confidentiality) (Poland) | |||
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Intention to use | Next time you want to get information on health-related questions, how likely are you to use the internet? (Europe) | |||
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Access frequency | Within the last 12 months, have you used the internet to search for health-related information? (Europe) | |||
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Type of information technology device | Please indicate if you have each of the following: tablet computer like an iPad, smartphone, etc? (HINTS) | |||
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Health-related web and app (software use) | What kind of health apps do you currently have on your phone? (HTS) | |||
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Web-based resource (governmental website, Wikipedia, etc) | Have you used any of the following internet resources for health information? (government websites, news sites, etc) (ANHCS) | |||
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Communication with health care provider | Haben Sie diese Gesundheits-Apps auf Ihrem Tablet oder Smartphone schon einmal dazu genutzt, … um auf Gespräche mit Ihrem Arzt, Heilpraktiker, Physiotherapeuten usw. besser vorbereitet zu sein? (Have you ever used these health apps on your tablet or smartphone...to be better prepared for discussions with your doctor, alternative practitioner, physiotherapist, etc? (HINTS Germany) | |||
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Communication with friends and others (social media, forum, etc) | Still thinking just about the last 12 months, have you posted a health-related question online or shared your own personal health experience online in any way? (HTS) | |||
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Health-related decision making | Haben Sie diese Gesundheits-Apps auf Ihrem Tablet oder Smartphone schon einmal dazu genutzt, …. um zu entscheiden, wie mit einer Erkrankung umgegangen werden sollte? (Has your tablet or smartphone…helped you make a decision about how to treat an illness or condition? (HINTS Germany) | |||
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Tracking/managing health state | Has your tablet or smartphone helped you track progress on a health-related goal such as quitting smoking, losing weight, or increasing physical activity? (HINTS) | |||
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Improvement of health knowledge | Improved your understanding of the symptoms, conditions, or treatments in which you were interested (Israeli survey) | |||
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Perceived health efficacy | Overall, how confident are you about your ability to take good care of your health? (HINTS) | |||
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Concerns and belief about health | Agree that my good health is largely a matter of good fortune (ANHCS) | |||
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General health state | How would you rate your level of health in general? (Europe) | |||
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Diseases diagnosed | Are you now living with any of the following health problems or conditions (diabetes, high blood pressure, etc) (HTS) | |||
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Height | How tall are you without shoes? (NHIS) | |||
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Weight | About how much do you weigh, in pounds, without shoes? (HINTS) | |||
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Mental health | Have you been diagnosed with any of the following medical conditions? (mental health condition) (ANHCS) | |||
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Caregiving | Are you a caregiver for an adult family member with any of the following medical conditions? (Alzheimer disease, cancer, etc) (ANHCS) | |||
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Social support | Is there anyone you can count on to provide you with emotional support when you need it, such as talking over problems or helping you make difficult decisions? (HINTS) | |||
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Perception about nutrition | How likely is it that eating 5 or more servings of fruits and vegetables every day will (make you look better)? (ANHCS) | |||
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Perception about physical activity | How likely is it that doing at least moderate exercise 3 or more times a week will (reduce your feelings of stress)? (ANHCS) | |||
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Perception about alcohol | How much do you agree or disagree with each of the following statements? (alcohol increases your risk of cancer) (HINTS) | |||
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Perception about tobacco | In your opinion, do you think that some smokeless tobacco products such as chewing tobacco, snus, and snuff are less harmful to a person's health than cigarettes? (HINTS) | |||
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Nutrition | In the past week, on average, how many servings of fruit did you eat or drink per day? Please include 100% fruit juice, and fresh, frozen or canned fruits. (ANHCS) | |||
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Physical activity | In a typical week, how many days do you do any physical activity or exercise of at least moderate intensity, such as brisk walking, bicycling at a regular pace, and swimming at a regular pace? (HINTS) | |||
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Alcohol | In your entire life, have you had at least 12 drinks of any type of alcoholic beverage? (NHIS) | |||
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Tobacco | Have you smoked at least 100 cigarettes in your entire life? (ANHCS) | |||
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Perception about cancer | 귀하께서는 다음 문항에 얼마나 동의하십니까? … 일상에서 접하는 모든 것이 암을 유발하는 원인임 (How much do you agree or disagree with each of the following statements? … It seems like everything causes cancer, There’s not much you can do to lower your chances of getting cancer, etc) (survey of CHISB) | |||||
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Cancer check-up | When did you have your most recent prostate-specific antigen test to check for prostate cancer? (ANHCS) | |||
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Cancer diagnosed | Have you ever been told by a doctor or other health professional that you had cancer or a malignancy of any kind? (NHIS) |
aHINTS: Health Information National Trends Survey.
bHTS: Health Tracking Survey.
cCHISB: cancer and health-related information–seeking behavior.
dNHIS: National Health Interview Survey.
eHTHS: Health Tracking Household Survey.
fANHCS: Annenberg National Health Communication Survey.
The channel can be defined as the means-focused domain that enables seekers to acquire and transmit health information [
The health domain refers to the seeker’s physical status and perceptions about health: overall health, lifestyle, and presence of cancer. Overall health refers to general health status, including physical, mental, and social health and concerns or beliefs about them. Lifestyle consists of 4 parts of a person’s behavior and attitude: nutrition, physical activity, alcohol consumption, and tobacco consumption. Cancer themes focused on check-up and diagnosis with cancer perceptions. Overall health was the most frequently found subdomain out of the 7 subdomains (average percentage 53.8%, SD 18.0). The other subdomains, namely, lifestyle and cancer, revealed an average percentage of 32.7% and 46.2% with SD 21.3 and SD 13.3, respectively (
A person is the subject of HISB who seeks and utilizes information. A person’s characteristics may affect HISB. The main considered characteristics throughout the instruments were age, sex or gender, nationality, race, language, education, income, occupational status, marital status, health literacy, health insurance, the number of household members, households with internet access, and preference for online or offline channels.
The spider web diagram shows the average percentage of the themes in the selected HISB tools. Survey of CHISB (South Korea) and HINTS (United States) accounted for 89% (51/57) and 88% (50/57), respectively, which were found to be high average percentages among the tools (
Average percentage of theme occurrence in health information–seeking behavior instruments. ANHCS: Annenberg National Health Communication Survey; HINTS: Health Information National Trends Survey; HISB: health information–seeking behavior; HTHS: Health Tracking Household Survey; NHIS: National Health Interview Survey; CHISB: cancer and health-related information–seeking behavior; TCS: Taiwan Communication Survey.
From the content analysis, representative sample questionnaire items from the 13 survey instruments were selected.
Through the content analysis, a theoretical framework emerged. This study proposed the information-channel-health structure for assessing HISB (
A proposed theoretical construct for health information–seeking behavior.
In this study, we investigated the main characteristics of the methodologies and the contents of the HISB survey tools used for over more than a decade (2008-2020) to answer the following research question: what are the characteristics of the measurement tools for assessing HISBs in nationally representative surveys around the world? The aim of this paper is to provide insights on the methodologies and the construct of content for HISB survey instruments from nationally representative studies. Through the systematic search, 13 survey tools were found in 2333 records related to HISB surveys. The features of this study’s results are comprehensive and not limited to specific countries and specific topics or issue-based research. Other HISB-related review studies reported specific data such as age, college enrollment, adulthood, needs, and disease, including adolescent disease [
The United States was found to have the most influential survey; 5 out of 13 tools developed in various countries were included in this study, a total of 188 research papers used data from HINTS, and HINTS identified 88% (50/57 themes) of the constructs, according to the findings. These strong features might be related to the purpose of HINTS to investigate respondents’ access to and use of health information, including information technology to manage health and health information. The composition of most of the questionnaire tools was continuously updated according to the change of the cycle. However, in the current survey of HINTS 5 Cycle 4, researchers changed its scope to focus on cancer compared to prior HINTS surveys, which focused on health and medical topics. Therefore, HINTS 5 Cycle 3 was included for the contents analysis part of this study. In particular, owing to the influence of COVID-19, the questionnaire in France was changed twice in 2020 only to reduce the time of survey completion.
The contents of each country’s survey tools contain the construct of HISBs. They can be categorized as information (information about health and patient medical records), channel (online and offline), and health (overall health state, lifestyle, and cancer), with dimensions of behavior and attitude. The questions are organized with more of the behavior dimension (average percentage of 53.8%) than attitude (average percentage of 30.4%) (
This study found that all the survey instruments were from high-income countries, that is, United States, European Union, France, Germany, Israel, Poland, South Korea, and Taiwan, of the Organization for Economic Co-operation and Development [
The degree of information technology development in the country also has a great influence on the questions. The question asking whether the respondent has computers or mobile/smart devices depends on the development of information technology and the retention rate of mobile phones in each country. As an extension of this question, questions were subdivided into digital literacy, the type of fitness app, and whether web-based chat groups were used for health-related topics. With HINTS as a standard, related studies from Germany, South Korea, and China were also developed. HINTS Germany was established by HINTS (United States) and supported by the National Cancer Institute. In the case of South Korea, an individual researcher developed the survey questionnaires based on the content of HINTS and was funded by a national institute. HINTS China was excluded in this study because researchers did not conduct a nationally representative sample survey of the country. These studies would enable cross-national trend analysis and agenda for HISB.
For this study, we used databases in English and Korean, but there are some survey instruments that are neither English nor Korean. To overcome this limitation, we did not limit the languages in the search process. Moreover, it is obvious that English is the universal language of publication in the research field in the era of globalization. Therefore, we also used surveys in other languages, including 1 from France (French), Germany (German), and South Korea (Korean) in this paper. Some full versions of HISB survey instruments were not available for the review process. To attain the instrument, the researchers emailed corresponding authors for the HISB survey tools; however, these were found to be not related to HISB, or the author refused to provide a full version, or we received no response. In addition, the duration of the literature search was restricted to the period between 2008 and 2020. However, we mitigated this limitation because this study’s findings cover the fundamental essence of HISB phenomena by analyzing existing tools over a more extensive period. The theoretical framework derived from this study could be used as a guide for nationally representative HISB surveys. From the findings of this study, we see that there was a lack of theoretical basis for the survey instrument. The framework including both the behavior/attitude and online/offline dimensions would provide integrative scope for national HISB phenomena. Moreover, this framework could be compared to other HISB-related theories, thereby enabling more comprehensive insight into the HISB phenomenon. As the study scope focused on HISB instruments that seek nationally representative samples, future studies could also analyze different populations, including certain regions, ages, genders, and occupations with HISB instruments. It would be worthy to compare the differences among the populations.
This study analyzed and synthesized current HISB survey questionnaires for nationally representative surveys. The findings of the methodology and content analysis provide a map and prototype for developing HISB-related instruments. A theoretical framework including both behavior/attitude and online/offline dimensions may provide integrative insight into real-world HISB phenomena. In sum, the findings of this study may contribute to better understanding of comprehensive HISB trends in nationally representative surveys.
Search strategies used for the study.
List of studies related to each health information–seeking behavior survey instrument tool.
Characteristics of the health information–seeking behavior survey instruments.
Theme occurrence table.
Annenberg National Health Communication Survey
cancer and health-related information–seeking behavior
Health Information National Trends Survey
health information–seeking behavior
Health Tracking Household Survey
National Health Interview Survey
Research Information Sharing Service
This research was supported by the National Research Foundation of Korea (NRF-2019R1F1A1058969, 2017R1D1A1B03035510) and Nambu University, 2020.We thank Jamie Conklin (Health Sciences Librarian at University of North Carolina at Chapel Hill) who helped in the search process.
None declared.