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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">JMIR</journal-id>
      <journal-id journal-id-type="nlm-ta">J Med Internet Res</journal-id>
      <journal-title>Journal of Medical Internet Research</journal-title>
      <issn pub-type="epub">1438-8871</issn>
      <publisher>
        <publisher-name>JMIR Publications</publisher-name>
        <publisher-loc>Toronto, Canada</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">v25i1e52877</article-id>
      <article-id pub-id-type="pmid">37991815</article-id>
      <article-id pub-id-type="doi">10.2196/52877</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Letter to the Editor</subject>
        </subj-group>
        <subj-group subj-group-type="article-type">
          <subject>Letter to the Editor</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Authors’ Reply: “The Problem of Investigating Causal Relationships Between Cognitive and Evaluative Variables”</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="editor">
          <name>
            <surname>Leung</surname>
            <given-names>Tiffany</given-names>
          </name>
        </contrib>
      </contrib-group>
      <contrib-group>
        <contrib id="contrib1" contrib-type="author" corresp="yes" equal-contrib="yes">
          <name name-style="western">
            <surname>Guetz</surname>
            <given-names>Bernhard</given-names>
          </name>
          <degrees>PhD</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <address>
            <institution>Carinthia University of Applied Sciences</institution>
            <addr-line>Europastraße 4</addr-line>
            <addr-line>Villach &#38; Klagenfurt, 9524</addr-line>
            <country>Austria</country>
            <phone>43 5905002453</phone>
            <email>guetz@fh-kaernten.at</email>
          </address>
          <xref rid="aff2" ref-type="aff">2</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0001-8909-0257</ext-link>
        </contrib>
        <contrib id="contrib2" contrib-type="author" equal-contrib="yes">
          <name name-style="western">
            <surname>Bidmon</surname>
            <given-names>Sonja</given-names>
          </name>
          <degrees>PhD</degrees>
          <xref rid="aff2" ref-type="aff">2</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0003-1615-2116</ext-link>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <label>1</label>
        <institution>Carinthia University of Applied Sciences</institution>
        <addr-line>Villach &#38; Klagenfurt</addr-line>
        <country>Austria</country>
      </aff>
      <aff id="aff2">
        <label>2</label>
        <institution>Department of Marketing and International Management</institution>
        <institution>Alpen-Adria-Universitaet Klagenfurt</institution>
        <addr-line>Klagenfurt</addr-line>
        <country>Austria</country>
      </aff>
      <author-notes>
        <corresp>Corresponding Author: Bernhard Guetz <email>guetz@fh-kaernten.at</email></corresp>
      </author-notes>
      <pub-date pub-type="collection">
        <year>2023</year>
      </pub-date>
      <pub-date pub-type="epub">
        <day>22</day>
        <month>11</month>
        <year>2023</year>
      </pub-date>
      <volume>25</volume>
      <elocation-id>e52877</elocation-id>
      <history>
        <date date-type="received">
          <day>18</day>
          <month>9</month>
          <year>2023</year>
        </date>
        <date date-type="accepted">
          <day>27</day>
          <month>10</month>
          <year>2023</year>
        </date>
      </history>
      <copyright-statement>©Bernhard Guetz, Sonja Bidmon. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 22.11.2023.</copyright-statement>
      <copyright-year>2023</copyright-year>
      <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/">
        <p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.</p>
      </license>
      <self-uri xlink:href="https://www.jmir.org/2023/1/e52877" xlink:type="simple"/>
      <related-article related-article-type="commentary-article" id="v25i1e45570" ext-link-type="doi" xlink:href="10.2196/45570" vol="25" page="e45570" xlink:type="simple">http://www.jmir.org/2023/1/e45570/</related-article>
      <related-article related-article-type="commentary-article" id="v24i11e37505" ext-link-type="doi" xlink:href="10.2196/37505" vol="24" page="e37505" xlink:type="simple">http://www.jmir.org/2022/11/e37505/</related-article>
      <kwd-group>
        <kwd>social influence</kwd>
        <kwd>physician rating websites</kwd>
        <kwd>patient satisfaction</kwd>
        <kwd>eHealth literacy</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <p>We appreciate the comments made by Konerding [<xref ref-type="bibr" rid="ref1">1</xref>] and are thankful for the opportunity to take part in this research dialogue. As described in detail in our paper [<xref ref-type="bibr" rid="ref2">2</xref>], the fact that social influence has an impact on the behavioral intention to use a technology has been postulated in numerous theories (eg, [<xref ref-type="bibr" rid="ref3">3</xref>]), with the Unified Theory of Acceptance and Use of Technology (UTAUT) [<xref ref-type="bibr" rid="ref4">4</xref>] being the most prominent one. This relationship has been tested and proven in many empirical studies (eg, [<xref ref-type="bibr" rid="ref5">5</xref>,<xref ref-type="bibr" rid="ref6">6</xref>]), usually by the application of a cross-sectional study design [<xref ref-type="bibr" rid="ref7">7</xref>]. Thus, we applied this methodology to our research domain in line with the UTAUT research stream.</p>
    <p>We are aware of the ongoing methodological debate about whether cross-sectional data are appropriate to test causal relations between variables. However, the application of a wide range of techniques for data collection and analysis has been the subject of continuing controversy in research for a long time [<xref ref-type="bibr" rid="ref8">8</xref>,<xref ref-type="bibr" rid="ref9">9</xref>]. In the past 3 years, the <italic>Journal of Medical Internet Research</italic> has published several studies applying a similar methodology to the one we have chosen (ie, creating a mediational model and testing it with cross-sectional data; eg, [<xref ref-type="bibr" rid="ref10">10</xref>,<xref ref-type="bibr" rid="ref11">11</xref>]). As Spector [<xref ref-type="bibr" rid="ref8">8</xref>] notes, there is perhaps no research design that has been more used, albeit more maligned, than the cross-sectional design. He underlines, however, that the longitudinal design’s ability to reflect causality has been overstated and is not advantageous as compared to the cross-sectional design in most cases of use.</p>
    <p>As Konerding [<xref ref-type="bibr" rid="ref1">1</xref>] states, causal relationships between cognitive and evaluative variables are very difficult to investigate. However, we tried to resolve this challenge by manipulating the independent variable. Thus, we even went a step further than other studies [<xref ref-type="bibr" rid="ref10">10</xref>,<xref ref-type="bibr" rid="ref11">11</xref>] by applying a mixed methods approach including an experimental setting. Although variables such as the credibility of online portals probably cannot be manipulated meaningfully, other methods such as the think-aloud method, eye-tracking, or neuroscientific methods could be considered for related research projects in the future.</p>
    <p>In his concluding sentence, Konerding [<xref ref-type="bibr" rid="ref1">1</xref>] suggests giving adequate consideration to methodological limitations when interpreting results. In this context, we agree but also note that all possible limitations referring to the methodology used in our research endeavor have been addressed within the published paper. Additionally, Konerding [<xref ref-type="bibr" rid="ref1">1</xref>] misstates the direction of influence in the proposed influencing paths (see the end of the second paragraph).</p>
    <p>Last, we do not agree that the study by Maddux and Rogers [<xref ref-type="bibr" rid="ref12">12</xref>] can be interpreted as a best practice example suitable for our research domain. We appreciate the authors’ theoretical contribution and merit but think that a sample size of 153 undergraduate students can be criticized regarding the weak representativeness and an increased probability of bias such as nonresponse [<xref ref-type="bibr" rid="ref7">7</xref>,<xref ref-type="bibr" rid="ref13">13</xref>]. Additionally, concerns about the inappropriate reliance on undergraduates have been raised since 1975 [<xref ref-type="bibr" rid="ref14">14</xref>].</p>
    <p>Taken together, we think that methodological discussions can be fruitful in general as long as they facilitate new ways of thinking.</p>
  </body>
  <back>
    <app-group/>
    <glossary>
      <title>Abbreviations</title>
      <def-list>
        <def-item>
          <term id="abb1">UTAUT</term>
          <def>
            <p>Unified Theory of Acceptance and Use of Technology</p>
          </def>
        </def-item>
      </def-list>
    </glossary>
    <fn-group>
      <fn fn-type="conflict">
        <p>None declared.</p>
      </fn>
    </fn-group>
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