Internet credibility: a case study in the field of

health information

(preliminar results)

Loughborough, 17/09/2012

Lluïsa Llamero

Summary

• Use of the Internet to look for health information• Why credibility matters?• Theories about credibility and Internet credibility• Methodology and sample• Results and discussion

Health information and the Internet

38% of European Population, 2011

Iceland, 61%Finland, 58%Denmark, Germany, 54%Spain: 38%UK: 36%

Source: Eurostat

Changing paradigm‘Informed patient’ (Kivits 2004):

Challenging authority of doctorsHelps in dealing with the illness

Doctors: Same criteria as traditional medical sources (recommendations)

Uncertainties: huge amount of data, disparate quality, disorganization, inadequacy of content, who to trust

Health information and the Internet

CredibilityConceptual tool

SelectAssess

Research Precedents:AristotleMass Communication Research (1950s)New interest after Internet popularization since 1990

How do users decide?

1. Information literacy: a checklist2. Unifying Framework of Credibility Assessment (Hilligoss y Rieh,

2008) 3. Prominence-Interpretation Theory (BJ. Fogg, 2003)4. Cognitive Authority Theory (Patrick Wilson 1983, Reijo Savolainen,

2007, Soo Young Rieh, 2008)5. Other studies: Rieh and Danielson (2007), Petty and Cacioppo

(1986), Metzger (2007), Wathen and Burkell (2002), Fritch and Cromwell (2001)

Theoretical frameworks

Multidimensional process in 3 levels : Construct

Truthfulness, expertise, trustworthiness...

HeuristicsContent, media, source, reputation, coherence...

InteractionVerification-contrasting, source evaluation, message clues

Context as a cross factor

Unifying Framework of Credibility Assessment

Social epistemology modelKnowledge:

First hand: better but limited Second hand: initial suspicion, the source needs the recognition as

an ‘authority’ to be trusted

Cognitive authority: The assessment is done by “indirect tests or indexes of credibility”

(Wilson, 1983) Facets/aspects: trustworthiness, truthfulness, scholarship,

credibility, officiality and competence What the cognitive authority says is “self knowledge”

Cognitive Authority Theory

Inaccuracy in the definition of the concept Ambiguity believability/credibility Very few explanations for Internet consumption

Limitations

Credibility is the quality of truth for information not directly witnessed by a receiver that is assessed through a series of attributes.

Credibility: an operational definition

Navigational interview Semi-structured It’s hold in front of a computer The informant can explain and show what they actually do (think aloud

protocol) Results: alows to gather explanations and do observation

Sample Doctors (familiy doctors and hospital doctors) Patients and relativesFieldwork : November 2011-February 2012

Methodology

H1 dependence on the contextH2 dependence on verificationH3 dependence on timeH4 appearance of levelling

Hypotheses

Doctors Construction: complex concept with equal importance of the

attributes (expertise, trustworthiness, believability)

P20. Credibility is related to truthfulness and the truth must be able to be checked, from a medical point of view, through what we call evidence-based medicine.

Results

P11. If you read an article in the British Medical Journal or similar journals, you already know that they have a code of ethics, that there isn’t a conflict of interest, etc.. and, for me, this is a source of credibility.

Results

Doctors Heuristics:

Reputed medical journals with impact factor (expertise) Oficial health sites (expertise) Medical associations (expertise) Blogs or webs by colleagues (trustworthiness) Message signs: methodology description (expertise) Updated content (expertise) Comparison among different sources (believability) Reminder for specific information-clinical practice (believability)

Results

Doctors Interaction:

P20. Many times, and although it contradicts what I’ve told you before, I use Google because we cannot disregard its results (...) many times it brings you to the same web places. Scientific databases and journals They use of Google (means of “transportation”, look for fast

information...) They look for the description of the source

Results

Patients

Motivation: to know more about their medical condition, dealing with the illness day by day (side questions), learning about scientific advances

Concept: expertise (medical-research credentials)

P15. I rather trust the opinion of a researcher... Maybe I trust more a researcher than a doctor because they have more expertise in a particular topic.

Results

Patients

Concept: expertise-trust-believability are strongly related

P16. The expert deserves my confidence, but not absolutely. If someone comes here and says ‘I am the king of cystic fibrosis research, I am doctor X...” I thoroughly observe him and I do not trust him blindly. First I have to trust. So, where does the trust come from? From a previous relationship. Expertise is important but must be combined with trust and plausibility, too.

Results

Patients

Concept: general scepticism on the Internet (just one case).

P17. In my view a doctor speaking on the TV or on the radio has more credibility because I guess that they have looked for an expert person or they talk about a book written by a professional. Internet to me, no. No, no, no. I don’t trust it enough.

Results

Patients Heuristics:

Reputation: recommendations of doctors, patients associations, friends (personal trustworthiness, cognitive authority), first results on Google (trust)

Relevance of content (believability) Journalistic articles (expertise) Affinity with other patients in web forums (believability) Checking with self knowledge and self experience with the illness

(believability) Contrasting with different sources through hyperlinks and search

engines, interactivity... (believability)

Results

Patients Interaction:

• expertise clues: medical-research authors, bibliography, scientific documents

• trustworthiness clues: look at the author description, officiality, recommendations by doctors, friends... delivered by e-mail, social networks, face to face interaction...

• trustworthiness-believability: Homophilia at forums (but weak credibility), comparisson

Results

Expert profile• H1 (context)

– Professional conventions• H2 (verification)

– Check with self knowledge

• H3 (time)– No effect

• H4 (levelling)– Quick assesment in interaction

• H1 (context)– Professional conventions

• H2 (verification)– Check with self knowledge

• H3 (time)– No effect

• H4 (levelling)– Quick assesment in interaction

General profile• H1 (context)

– Cognitive authorities

• H2 (verification)– Ask doctors– Contrast-hypertext

• H3 (time)– Learning and checking

• H4 (levelling)– General trust in forums– Fear of using information

• H1 (context)– Cognitive authorities

• H2 (verification)– Ask doctors– Contrast-hypertext

• H3 (time)– Learning and checking

• H4 (levelling)– General trust in forums– Fear of using information

Results

Discussion

• Complex and multidimensional concept• Context and user’s skills influence credibility processes • First inventory of heuristics and interaction practices• Caution in consumption• Further research:

– Other informational contexts– Produsers sample– Digital natives sample

Thank you for your attention!lluisa.llamero@urv.cat

Blog: http://digicreder.blogspot.com/