JMIR Publications

ABSTRACT

Background:

The widespread adoption of the internet has established online health information seeking behavior(OHISB) as a primary channel for public health knowledge acquisition, potentially reshaping patient adherence behaviors and doctor-patient dynamics. However, the underlying pathways, particularly the role of doctor-patient communication efficacy and the differential impact of various digital platforms, remain underexplored, especially among rural populations.

Objective:

This study examined the relationship and underlying pathways between online health information-seeking behavior(OHISB) and patient adherence among rural residents in China, with a specific focus on the mediating role of doctor-patient communication efficacy and the moderating associations of different platform types.

Methods:

A cross-sectional survey was conducted from June 2023 to October 2024 using a multi-stage stratified sampling method across six Chinese provinces. Participants were rural residents aged 18-70 with recent healthcare experiences. Data from 7,004 valid questionnaires were analyzed. A fixed effects model assessed the primary association, with robustness checked via LASSO regression. Mediation analysis using the bootstrap method examined the indirect pathway through doctor-patient communication efficacy, and interaction terms tested interactions with platform type (internet hospitals, professional platforms, WeChat accounts, short-video apps, search engines).

Results:

OHISB showed a significant direct positive association with patient adherence (β = 0.260, P < 0.001). Doctor-patient communication efficacy represented a significant negative indirect pathway (β = -0.026, P < 0.001), accounting for 9.29% of the total association. Platform type significantly moderated the relationship: internet hospitals (β = 0.099, P < 0.05), professional platforms (β = 0.081, P < 0.05), and WeChat accounts (β = 0.032, P < 0.05) enhanced the positive pathway of OHISB, whereas short-video platforms (β = -0.034, P < 0.01) and search engines (β = -0.204, P < 0.001) weakened it.

Conclusions:

Online health information seeking among rural residents is directly associated with better patient adherence, but this benefit is partially offset by a negative indirect pathway through reduced doctor-patient communication efficacy. The association of OHISB on adherence varies significantly by platform type. Findings highlight the need for digital health equity strategies, interventions to improve communication efficacy and health literacy, and graded management of health information platforms.