With the increasing awareness of health consumers as active information seekers, the past decade has witnessed a shifting research interest from a physician-centered paradigm to a consumer-centered paradigm. Online health information seeking (OHIS) has become pervasive, with critical impacts on consumers' health. However, the inherent complexity and the uniqueness of health tasks pose new challenges to consumers in OHIS, such as a lack of adequate knowledge to formulate queries and evaluate the online resources with various qualities. OHIS is, by nature, a learning-oriented behavior, and knowledge learning is a critical component and outcome of consumers' OHIS. On the other hand, studies in the area of search as learning (SAL) have demonstrated that learning is a common phenomenon in the information-seeking process. However, the existing studies in OHIS mainly concentrated on viewing consumers' domain knowledge as a fixed value, even though consumers are involved in the knowledge learning in the OHIS. Therefore, this dissertation proposes a conceptual framework of health information search as learning (HearSAL) by linking the related models and prior studies from the two areas — OHIS and SAL — and conducts a systematic study to understand what, how, and how well health consumers can search and learn in online health information seeking, particularly for three increasing levels of learning objectives: Understand, Analyze and Evaluate.
Two representative health consumer groups, laypeople and cancer patients, are targeted in this dissertation study because they share the common issue of facing barriers in searching and learning in OHIS, yet they are different due to prior topic knowledge, learning duration, and learning expectation. Following the conceptual framework HearSAL, four sub-studies are conducted with emphasis on different dimensions of health consumers' search as learning in OHIS, including the following: Study 1: a user study with laypeople that examines the method dimension (e.g., search behaviors and source selections); Study 2: an analysis of an ovarian cancer online health community that reveals the information dimension (e.g., types and amount of information); Study 3: interviews with laypeople; and Study 4: interviews with ovarian cancer patients and caregivers. The two complementary interviews highlight the outcomes of OHIS.
Major results demonstrate that, (1) health consumers’ SAL behaviors and sources vary by different levels of learning objectives, and the variation is affected by the severity of health conditions; (2) Analyze is the most prevalent learning objective in the online health community, while the amount of informational support is the highest in the Evaluate level; (3) Though consumers’ prior knowledge of the Understand level is the highest, compared to higher levels, consumers still tend to achieve the most knowledge increase in the Understand level of learning; and (4) Receiving more informational support drives consumers to increase the level of learning objectives.
This dissertation makes empirical, practical, theoretical and methodological contributions. The empirical studies of laypeople and ovarian cancer patients provide a deeper insight into health consumers' SAL behavior and performance in today's web environment. Based on the empirical results, practical implications are proposed for designing consumer-centered health information systems, which facilitate seeking and enhance learning. Finally, the HearSAL framework and its application in this study can serve as a theoretical and methodological basis for future explorations
