Future Directions in Online Healthcare Consumerism Policy Making: Exploring Trust Attributes of Online Healthcare Information
by Ankur Chattopadhyay and Katie L. Turkiewicz
As originally published in the March issue of the IEEE Internet Policy Newsletter
The internet profoundly impacts the way people search for, utilize, and communicate about healthcare information. Eight out of 10 Americans report searching online for healthcare information . More specifically, 83% indicated using the internet to look up a particular disease or a medical problem . There is an enormous amount of Online Health Information (OHI) available for users. However, there is lack of standardization in setting guidelines of credibility standards for OHI. In other words, there are no standard mechanisms or policies for regulating online healthcare consumerism to help users make ‘trust’ decisions while using OHI . Although, active OHI users make such ‘trust’ judgments all the time, there is no standard policy driven method or approach to comply with the rationale of making such decisions.
The topic of “online information trust” is an important issue in context of health information acquisition. The trust issue on OHI recently got attention since a large number of American youth is inclined towards using the World Wide Web to self-diagnose, seek treatment and/or to choose a right physician. The difficulty to find accurate information , inconsistent advice or information [5, 6], the ambiguity in health information  and the psychological distress resulting from the information seeking process  are all examples of some of these challenges. Cyberchondria is a growing challenge and leverages anxiety and other medical disorders . Research on cyberchondria suggests that some people are particularly vulnerable to bouts of distress related to OHI seeking. Individuals with increasing anxiety have been reported saying that OHI is more distressing and anxiety provoking. Interestingly, anxiety has a direct correlation with the search frequency and the duration of OHI searches . This cyclical pattern of distress and information seeking has detrimental effects on the individual, who is generally already suffering from an acute or chronic health condition that prompted the initial search.
Cyberchondria has been considered a distinct mental disorder and a multidimensional concept with mistrust of medical professionals as one of its key features . The notion of trust can be attributed to a multi-dimensional and a multi-disciplinary concept with a complex interpersonal connotation and social context [2, 12-16]. Soft trust attributes [17, 18] in context of OHI represents the unverified (or raw) online information contents, including non-validated consumer reviews and other soft data available on the web. Hard trust attributes [17, 18] in OHI, on the other hand, refer to the verified or validated data. The OHI seeking and cyberchondria related trust issues have never been researched from the computing disciplinary perspective of soft trust and hard trust components.
An important component of trust has to do with rejection or selection of a particular site by the user. Existing literature [5, 6] indicates that users will engage with sites they visit as trustworthy and reject those they mistrust. Research in the area of OHI trust suggests that mistrust of websites is based on design factors such as choice of images . Trust on OHI websites could also be based on content factors such as source credibility and personalization [5, 6]. Researchers [19, 24] argue that design is one factor that influences users to trust OHI websites with better outlook and mistrust those with poor visual design. Thus, web images as part of the design or visual appeal can play an important role in user trust of OHI.
Discussion  highlights that the influence of cyberchondria can be minimized if online healthcare users can find an easy way of determining the trustworthiness of an OHI website. A future research direction in online healthcare consumerism related policies is potentially exploring the need for persuasive imagery in building trust in OHI. This line of research involves the use of visual profiles at the provider level for building further trust in published OHI. The requirement of establishing trustworthiness in OHI as part of information assurance can possibly be addressed through authentication. Recent literature [5, 6, 13 and 19] emphasizes the development of trust in OHI through systematic evaluation of contents. It is claimed that internet users gain trust on OHI upon verifying the information through crosschecking with other online resources. Credibility and acceptability are two contributing factors towards trustworthiness of OHI [12, 16 and 25]. As a future research direction in determining OHI trustworthiness, authentication can be employed to influence these factors of credibility and acceptability in order to better serve online healthcare consumerism. A possible innovation in this line of research could be driven by the novel idea of employing biometrics  based authentication in order to improve OHI content evaluation.
Recent related research from the field of e-commerce and social media in regard to trust, authentication, and reputation-based research [21, 22 and 23] have looked into the user trust, confidence and credibility levels using social profiles. They have used techniques like machine learning-based classification and analysis to cross-validate online content through authentication and verification via trusted sources. However, OHI trust computing research has not directly used machine learning to deal with trust and reputation. Additionally, previous trust computing models in OHI [12, 16 and 26] have employed user-centric models for evaluating trust. These models have been limited to covering trust constructs at the consumer and the website levels [14, 27].
Existing studies [2, 19 and 26] argue that trust is a multi-dimensional entity and needs to be expanded to a broader context by considering trust inducing factors at the institutional level. Most OHI trust related research [15, 27 and 28] has traditionally accounted for only trustor-focused attributes. They have typically neglected the organizational trust antecedents like expert (or provider) profile, reputation, verification, familiarity, and social identity [14, 27]. In order to fill in these holes in OHI trust related research, future research needs to focus upon provider-centric computing models, which extend the determination of trustworthiness to the trustee level by including institutional trust components.
Additionally, future research on making of policies, in regard to posting OHI, needs to look at the reliability issue from the perspective of both soft trust and hard trust [17, 18], and not just one of them. Research in the OHI trust related domain has mostly been focused on only soft trust . However, future OHI policy making has to include hard trust within its research context along with soft trust for improving the consumer trust building process. For instance, providing a mechanism for cross-validation of providers might represent a hard-trust mechanism in OHI consumerism. In fact, integrating soft trust with hard trust  should be the way ahead for influencing the trust-based decision making of OHI seekers. A hybrid trust model integrating soft trust elements with hard trust can lead to more credibility of OHI and help develop more confidence in users. It can provide more peace of mind to OHI users for important healthcare decisions and can counter cyberchondria in the process.
The above suggested hybrid approach in OHI trust research will improvise verification of OHI trustworthiness, and will assist in forming a more comprehensive and effective indicator to credibility in OHI. As discussed, the research gaps in existing literature also suggest that future policy making in driving online healthcare consumerism should address the institutional trust antecedents beyond the usual scope of the consumer and the website. As mobile technology continues to seamlessly integrate into the modern lifestyle and the national healthcare system continues to be intractable, it is imperative to have effective policies and reliable compliance standards for determining the credibility, authenticity, and acceptability of OHI. The discussed future research directions on reliability of OHI will bring innovation in trust inducing policy making to better serve online healthcare consumerism.
- Fox, Susannah. “Mobile Health 2010.” Pew Internet and American Life Project.
- Khosrowjerdi, Mahmood. “A review of theory-driven models of trust in the online health context.” IFLA journal 42, no. 3 (2016): 189-206.
- Singal, Himani, and Shruti Kohli. “Escalation of TRUST analysis in web.” In Proceedings of the 12th ACM International Conference on Computing Frontiers, p. 56. ACM, 2015.
- Barbara, Angela M., Maureen Dobbins, R. Brian Haynes, Alfonso Iorio, John N. Lavis, Parminder Raina, and Anthony J. Levinson. “The McMaster Optimal Aging Portal: Usability Evaluation of a Unique Evidence-Based Health Information Website.” JMIR Human Factors3, no. 1 (2016).
- Sillence, Elizabeth, Pam Briggs, and Peter R. Harris. “Healthy persuasion: web sites that you can trust.” In Persuasive Technology and Digital Behaviour Intervention Symposium. 2009.
- Sillence, Elizabeth, and Pam Briggs. “The Evolution of Trust in a Design Context.” Design and semantics of form and movement 30 (2007).
- Brainin, Esther, and Efrat Neter. “Inside Technology: Opening the Black Box of Health-Website Configuration and Content Management.” Future Internet 6, no. 4 (2014): 773-799.
- Turkiewicz, K. L.,“Cyberchondria scale construction: The Cyberchondria Assessment Measure (CYCAM)”. Paper presented at the Central States Communication Association Conference, Cleveland, OH. Health Communication Interest Group, (2012).
- White, Ryen W., and Eric Horvitz. “Cyberchondria: Studies of the escalation of medical concerns in web search.” ACM Transactions on Information Systems27, no. 4 (2009): 1-37.
- Muse, Kate, Freda Mcmanus, Christie Leung, Ben Meghreblian, and J. Mark G. Williams. “Cyberchondriasis: Fact or fiction? A preliminary examination of the relationship between health anxiety and searching for health information on the Internet.” Journal of Anxiety Disorders26, no. 1 (2012): 189-96.
- Starcevic, Vladan, and Elias Aboujaoude. “Cyberchondria, cyberbullying, cybersuicide, cybersex:“new” psychopathologies for the 21st century?” World Psychiatry 14, no. 1 (2015): 97-100.
- Singal, Himani, and Shruti Kohli. “Trust Necessitated through Metrics: Estimating the Trustworthiness of Websites.” Procedia Computer Science 85 (2016): 133-140.
- Kostagiolas, Petros, Nikolaos Korfiatis, Panos Kourouthanasis, and Georgios Alexias. “Work-related factors influencing doctors search behaviors and trust toward medical information resources.” International Journal of Information Management 34, no. 2 (2014): 80-88.
- Johnson, Frances, Jennifer Rowley, and Laura Sbaffi. “Modelling trust formation in health information contexts.” Journal of Information Science (2015): 0165551515577914.
- Vega, Laurian C., Tom DeHart, and Enid Montague. “Trust between patients and health websites: a review of the literature and derived outcomes from empirical studies.” Health and technology 1, no. 2-4 (2011): 71-80.
- Singal, Himani, and Kohli, Shruti. “Mitigating Information Trust: Taking the Edge off Health Websites” International Journal of Technoethics (IJT) 7, no. 1 (2016): 16-33.
- Chattopadhyay, Ankur. “Developing an Innovative Framework for Design and Analysis of Privacy Enhancing Video Surveillance.” PhD diss., University of Colorado Colorado Springs. Kraemer Family Library, 2016.
- Msanjila, Simon S., and Hamideh Afsarmanesh. “On hard and soft models to analyze trust life cycle for mediating collaboration.” In Working Conference on Virtual Enterprises, pp. 381-392. Springer Berlin Heidelberg, 2009.
- Sillence, Elizabeth, and Pam Briggs. “Trust and Engagement in Online Health A Timeline Approach.” Handb PsycholCommun Technol 33 (2015): 469-87.
- Alpaslan, Ahmet Hamdi. “Cyberchondria and adolescents.” Social Psychiatry 1 (2016): 2.
- Yap, Mohamad Nazri Khairuddin, Massila Kamalrudin, Ahmad Zaki A. Bakar, and Safiah Sidek. “VERIFICATION ON THE TRUSTWORTHINESS OF INFORMATION: A STUDY.” Journal of Theoretical and Applied Information Technology 92, no. 1 (2016): 72.
- Sänger, Johannes, and Günther Pernul., “TRIVIA: visualizing reputation profiles to detect malicious sellers in electronic marketplaces.” Journal of Trust Management 3, no. 1 (2016): 5.
- Giasemidis, Georgios, Colin Singleton, Ioannis Agrafiotis, Jason RC Nurse, Alan Pilgrim, Chris Willis, and Danica Vukadinovic Greetham. “Determining the veracity of rumours on Twitter.” In International Conference on Social Informatics, pp. 185-205. Springer International Publishing, 2016.
- Lazard, Allison J., and Michael S. Mackert. “E-health first impressions and visual evaluations: key design principles for attention and appeal.” Communication Design Quarterly Review 3, no. 4 (2015): 25-34.
- Kim, Yeolib. “Trust in health information websites: A systematic literature review on the antecedents of trust.” Health informatics journal (2014): 1460458214559432.
- Martínez-Sarriegui, Iñaki, Fernando García-García, Gema García-Sáez, M. Elena Hernando, and Michael Luck. “TRHIOS: Trust and reputation in hierarchical and quality-oriented societies.” In Information Systems and Technologies (CISTI), 2012 7th Iberian Conference, pp. 1-4. IEEE, 2012.
- Rafe, Vahid, and Maryam Monfaredzadeh. “A qualitative framework to assess hospital/medical websites.” Journal of medical systems 36, no. 5 (2012): 2927-2939.
- Corritore, Cynthia L., Susan Wiedenbeck, Beverly Kracher, and Robert P. Marble. “Online trust and health information websites.” International Journal of Technology and Human Interaction (IJTHI) 8, no. 4 (2012): 92-115.
- Lin, Ching, and Vijay Varadharajan. “A hybrid trust model for enhancing security in distributed systems.” In Availability, Reliability and Security, 2007. ARES 2007. The Second International Conference on, pp. 35-42. IEEE, 2007.
Dr. Ankur Chattopadhyay is an Assistant Professor in the Information and Computing Sciences (ICS) department at the University of Wisconsin, Green Bay. Chattopadhyay is a computer scientist as well as a computer engineer, and has a Ph.D. in computer science from the University of Colorado. His research interests include information assurance and security, computer vision, pattern recognition, image processing & analysis and computer science education. He has published and presented in international conferences like ACM SIGCSE, IEEE CVPR and IEEE FIE. Chattopadhyay has more than 16+ years of experience in both academics and industry. As an academician, his passion is teaching computer science, conducting research in multiple computing disciplines and applying his research to bring about innovation as well as improve computer science education. His industry profile includes multiple roles such as IT analyst, software engineer and embedded systems engineer, having worked with Tata Consultancy Services for several years.
Dr. Katie L. Turkiewicz is an Assistant Professor in the Information and Computer Science Department at the University of Wisconsin, Green Bay. She received her MA and Ph.D. from the University of Wisconsin, Milwaukee where her research focus included online health information seeking practices. Turkiewicz continues to explore the impact of counterproductive online health information seeking on the provider-patient relationship in addition to the impact of new technology on health.
Dr. Syed Ahmad Chan Bukhari is a semantic data scientist, a tech consultant and an entrepreneur. He received his PhD in computer science from University of New Brunswick, Canada. He is currently working as postdoc associate at Yale University, School of Medicine and at National Center for Biotechnology Information (NCBI) under scientific visitor’s program. At Yale, he is working as part of two NIH-funded consortia, the Center for Expanded Data Annotation and Retrieval (CEDAR, http://metadatacenter.org) and the Human Immunology Project Consortium (HIPC, http://www.immuneprofiling.org). Dr. Bukhari specific research efforts are concentrated on several core problems from the area of semantic data management. On the standards side, his focus is on the development of metadata and data standards development, and improving data submission and reuse through the development of methods that leverage ontologies and semantic web technologies. As part of the AIRR community (AIRR, http://airr.irmacs.sfu.ca) data standards working group, Dr. Bukhari with his colleagues have introduced an initial set of ontology-aware metadata recommendations for publishing AIRR sequencing studies. On the application side, his research aims are providing non-technical users with scalable self-service access to data, typically distributed and heterogeneous. Semantic technologies, based on semantic data standards and automated reasoning, alleviate many data access-related challenges faced by biologists and clinicians, such as data fragmentation, necessity to combine data with computation and declarative knowledge in querying, and the difficulty of accessing data for non-technical users. As an entrepreneur, Dr. Bukhari and his team is working on the development of a collaborative annotation toolkit for radiologist. His startup scaai labs (http://scaailabs.com) was in top-ten innovators list of 2015 contest at sillicon valley (http://www.globaltechsymposium.com/innovators.html). His research and entrepreneurial work has been picked by the CBC Canada, PakWired, and UNB News.