Seeking But Not Discussing Online Health Information With Physicians: Cross-Sectional Survey Study of eHealth Literacy-Empowerment Profiles and Patient-Centered Communication.

Abstract

Patients frequently search for health information online and value physician support in evaluating and interpreting their findings, yet many hesitate to share their online searches with their physicians. This hesitation hinders shared decision-making and compromises patient care. While extensive research has examined patients' online health information-seeking behaviors, little has focused on patients' disclosure of this information to their physicians during consultations. Guided by the Health Empowerment Model and the Linguistic Model of Patient Participation in Care, this study aims to (1) identify distinct patient profiles based on eHealth literacy and psychological health empowerment levels, (2) examine how these patient profiles differ in online health information seeking and disclosure to physicians, and (3) investigate whether patient-centered communication (PCC) promotes information disclosure and whether this effect varies by patient profile. This cross-sectional study surveyed 2001 Chinese participants recruited through convenience sampling. Patient profiles were identified using k-means cluster analysis with standardized z scores of eHealth literacy and psychological health empowerment. Differences between profiles in information behaviors were examined using 1-way Welch ANOVA, chi-square tests, and pairwise comparisons. Regression analyses examined the association between PCC and disclosure of online health information. Moderation analyses using the Hayes PROCESS macro assessed whether this association varied across patient profiles. Four distinct patient profiles were identified: effective self-managers (996/2001, 49.8%), moderate-needs dependent patients (408/2001, 20.4%), high-needs patients (68/2001, 3.4%), and dangerous self-managers (529/2001, 26.4%). Profiles differed significantly in information-seeking intentions (F_3,289=62.09; P<.001; η²=0.12) and disclosure intentions (F_3,299.41=66.08; P<.001; η²=0.09). "Effective self-managers" showed the highest seeking (mean 4.01, 95% CI 3.96-4.06) and disclosure intentions (mean 3.43, 95% CI 3.36-3.50), while "high-needs patients" showed the lowest intentions for both behaviors. Actual information-seeking rates also differed significantly across profiles (χ²₃=103.4; P<.001), with "effective self-managers" having the highest rate (800/996, 80.3%) and "high-needs patients" the lowest (25/68, 36.8%). Among seekers, disclosure rates varied significantly (χ²₃=23.1; P<.001), with "high-needs patients" showing the highest disclosure (16/25, 64%) despite having the lowest seeking rate. PCC was positively associated with actual information disclosure behavior (odds ratio 1.26, 95% CI 1.04-1.53; P=.02), with no significant moderation by patient profiles (χ²₃=1.7; P=.64). This study extends existing literature from information-seeking behavior to patients' disclosure of online findings to physicians. Unlike prior research that examined eHealth literacy and psychological health empowerment separately, this study integrated these constructs to identify meaningful patient profiles with distinct information behavior patterns. PCC facilitates disclosure regardless of patient profile. For practice, physicians should adopt a PCC that acknowledges patients' online research efforts, promoting safer information use and stronger patient-physician relationships.