JMIR Publications

ABSTRACT

Online information, accessed through social media, websites, apps and artificial intelligence, is frequently described as shaping health attitudes and decision-making. Many methodological approaches to understanding how online information influences decisions provide important insights into online content, information exposure, or user perspectives, but often struggle to capture the personalised and algorithmically curated digital environments people encounter, how they engage with information as it appears in their everyday lives, and how such encounters intersect with wider social, cultural and personal contexts to shape decision making. New methodological approaches are needed that can generate meaningful evidence about the varied realities of navigating online health information and the role it plays in decision-making. Drawing on reproductive justice and feminist principles that privilege participant expertise and lived experience and informed by literature and collaboration with lived and learnt experts, we co-designed a participant-centred longitudinal content-oriented study exploring the influence of online information on contraceptive decision-making. Inspired by Photovoice approaches, participants documented in real time the online information they encountered over a one-month period, capturing content presented through their own tailored digital environments. Interviews conducted before and after the collection period explored contraceptive experiences, attitudes, decision-making and reflections on the role of online information. By combining real-time documentation with in-depth interviews, this approach enabled interpretations of participants lived encounters with online information, including algorithmic changes, emerging trends, current events, and the types of content that resonated with them. Collaborators with lived experience were involved throughout the methodological development and interpretation and analysis of findings. This participant-selected content-oriented longitudinal design demonstrates the value of methodologies that capture and generate evidence on lived digital and offline realities as they unfold in real time. Understanding how online information shapes health decision-making requires moving beyond approaches that treat the internet as an isolated and static influence on behaviours. Online information is not a singular, stable object of inquiry but dynamic, personalised, algorithmically mediated and embedded within broader social, cultural, and political contexts. Methodologies that recognise this complexity are essential for generating evidence capable of informing empathetic and meaningful health care and support and care for people prioritising their needs and navigating complex health decisions.