JMIR Publications

ABSTRACT

Background:

The Internet continues to offer new forms of support for health decision making. Government, charity and commercial health websites increasingly offer a platform for shared personal health experiences and these are just some of the opportunities that have arisen in a largely unregulated arena. Understanding how people trust and act on the information they find online has always been an important issue and remains so, particularly as the design practices of health websites continue to evolve and raise further concerns and challenges regarding their trustworthiness.

Objective:

The objective of the current study was to identify the key factors influencing US and UK citizens’ trust and intention to act on advice found on health websites and give particular focus to the role of patient experiences.

Methods:

1123 users took part in an online survey (625 from the US and 498 from the UK). They were asked to recall their previous visit to a health website. The online survey consisted of an updated general web trust questionnaire to account for personal experiences plus questions assessing key factors associated with trust in health websites (information corroboration and coping perception) and their intention to act. We performed Principle Components Analysis (PCA) and then explored the relationship between the factor structure and outcomes by testing its fit to the sampled data using structural equation modelling (SEM). We also explored the model fit across US and UK populations.

Results:

PCA of the general web trust questionnaire revealed four trust factors: (i) personal experiences, (ii) credibility and impartiality, (iii) privacy and (iv) familiarity. In the final SEM model, trust was found to have a significant direct effect on intention to act (β=.59, P<.001) and of the trust factors, only credibility and impartiality had a significant direct effect on trust (β=.79, P<.001). The impact of personal experiences on trust was mediated through information corroboration (β=.06, P= .039). Variables specific to eHealth (information corroboration and coping) were found to substantially improve the model fit and differences in information corroboration were found between US and UK samples. The final model accounting for all factors achieved a good fit (GFI (.95), AGFI (.93), RMSEA (.50) and CFI (.98)) and explained 65% of the variance in trust and 41% of the variance in intention to act.

Conclusions:

Credibility and impartiality continues to be a key predictor of trust in eHealth websites. Websites with patient experiences can positively influence trust but only if users first corroborate the information through other sources. The need for corroboration was weaker in the UK, where website familiarity reduced the need to check information elsewhere. These findings are discussed in relation to existing trust models and the relationship between patient experiences and health literacy. Clinical Trial: N/a