Does the ownership of health website matter? A cross-sectional study on Chinese consumer behavior

https://doi.org/10.1016/j.ijmedinf.2021.104485Get rights and content

Highlights

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    Both Chinese consumers’ perceived credibility and actual use of health website varied by ownership.

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    The organizational health website was the most credible one, while the commercial health website was the most commonly used one.

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    Most sociodemographic factors were not significantly correlated with the perceived credibility, actual use of health websites.

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    City income level, consumer type and consumer income level were significantly associated with perceived credibility, actual usage of health websites.

Abstract

Background

Ownership has significant impact on website motivation. Consumers may heavily rely on the health website ownership cue when assessing credibility and making behavioral response toward health information on it. Health websites were primarily divided into four different ownership types (i.e., governmental, organizational, commercial, and personal) in China’s context. However, research on Chinese consumer behavior toward different ownership types of health websites is scarce.

Objectives

To investigate the most credible and most commonly used health website ownership type among Chinese consumers, and to identify the influencing factors on perceived credibility, and actual usage of health websites.

Methods

A cross-sectional survey of 1653 participants was conducted in 3-tier hospitals in 3 cities with different income levels. Multinomial logistic regression analyses were used to identify factors influencing Chinese consumers’ perceived credibility and actual use of health websites.

Results

The most credible health website was the organizational, followed by the governmental, commercial, and personal. The most commonly used health website was the commercial, followed by the organizational, governmental, and personal. Individuals in medium-income and low-income cities were more likely than those in high-income cities to trust and use non-governmental health websites. Compared to the governmental health website, consumers of high-level hospitals were less likely than those of primary hospitals to trust and use personal health websites. Compared to the governmental health website, high-income individuals were more likely than low-income individuals to trust the personal health website, and use the organizational and commercial health website.

Conclusions

Both Chinese consumers’ perceived credibility and actual use of health website varied by ownership, and there was a gap between perceived credibility and actual usage of health website. Most sociodemographic factors had no statistically significant correlations with perceived credibility and actual usage of health website. City income level, consumer type and consumer income level were significantly associated with perceived credibility, actual usage of health websites.

Introduction

The internet has become a prime source of health information for most people. Health-related individuals and entities have strived to make health information online available to their users. In the fiercely competitive online health information and service market, health websites are increasingly becoming major market players, and internet users’ perceived credibility of online health information focuses on a source’s perceived motivation (trustworthiness) rather than ability (expertise). Website motivation is likely driven by its ownership. Health websites and apps vary in ownership, and there should be noticeable differences across commercial, nonprofit and governmental health websites, as they must respond to different structural incentives and constraints, motivations, purposes [1,2]. Obviously, different ownership types of health websites have different motivations, and consumers use health website ownership cue to assess the source credibility of online health information and make responses on it.

After State Council of China issued the guideline on Internet Plus Healthcare in April 2018, various ownership types of health websites have tremendously increased their presences in the online health information and service market. Hence, research on consumers’ behavior toward different ownership types of health websites is critically important to understand the market structure and future development of online health information and service industry. However, research on consumers’ behavioral beliefs and responses toward different ownership types of health websites is scarce. Specifically, there is a lack of studies to explore Chinese consumers’ online health information seeking behavior in relationship with website ownership. We aimed to fill the research gaps and further extend understanding of special characteristics of China’s online health information and service market by conducting cross-sectional survey at different types of hospitals in different income level cities.

Section snippets

Credibility of online health information source

Health information seeking behavior (HISB) is a popular research domain which includes the perceived credibility, intention to use, actual use and continuing intention to use of online health information. In the Web environment, perceived credibility (often referred to as trust) is a supremely key concern, necessitating the constant need to critically assess information while consuming it [3]. Previous studies have suggested that perceived credibility significantly influences consumers’

Material and methods

The Health Information National Trends Survey (HINTS) is a cross-sectional survey of the U.S. National Cancer Institute to measure how U.S. adults access and use health information. Based on the HINTS, we made some modifications in accordance with China’s context and research questions to design our questionnaire survey.

Sociodemographic characteristics and medical information seeking

76.64 % (1145/1494) of adult participants reported that they had sought medical information online before. Table 1 shows sociodemographic characteristics of adult participants and medical information seekers. There were more females than males. The majority of both participants and seekers had characteristics of being college graduate, aged 18–55, being married or single, being in good or fair health status, being active in internet use. Compared to other variables, monthly income was equally

Gap between credibility and actual use

This study has testified the hypothesis that Chinese consumers’ perceived credibility and actual use of health website varied by ownership. Many previous studies have found that hospitals, universities, government agencies, and well-known non-profit organizations are more trustworthy health website owners/sponsors for health information seekers [22,23,26,29]. Owing to the fact that there is no educational/academical institutions offering direct-to-consumer online medical/health information for

Limitations and future research

This study has several limitations. First, there is urban-rural divide in China. As rural population was not included in the survey, our sample would overestimate the whole population’s health information source seeking behavior, we would extend our study by conducting survey on both urban and rural population in the future. Second, different ownership types of health websites varied in their provisions of information and services. Provision of health/medical information and knowledge was the

Conclusion

This article contributes to the literature, because it is, to our knowledge, the first study to examine Chinese consumers’ behavior toward different ownership types of health websites. This study results have indicated health website ownership mattered for Chinese consumers, and there was a gap between credibility and actual usage of health website in terms of ownership. This study has identified that income level of city, consumer type and income level of individual were significantly

Authors’ contributions

Liyun Liu: Conceptualization and design of the study; investigation, acquisition, analysis and interpretation of data; writing of original draft, revising and editing of the article, and final approval of the submission. Lizheng Shi: Design of the study; analysis and interpretation of data, revising and editing of the article, and final approval of the submission.

Summary table

What was already known on the topic?

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    Consumers use website ownership as an important indicator to assess online health information quality.

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    Health websites owned by governments, reputable organizations, educational and academic institutions, health institutions are considered as more trustworthy sources of health information.

What this study added to our knowledge?

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    This study examined the consumer’s behavior (perceived credibility and actual usage) toward different ownership types of health

Declaration of Competing Interest

The authors report no declarations of interest

Acknowledgments

This work was supported by MOE (Ministry of Education, China) Project of Humanities and Social Sciences (grant: 18YJC630100), Natural Science Foundation of Zhejiang Province, China (grant: LY19G030007), China Scholarship Council (grant: 201908330565). The funder had no role in the design of the study; collection, analysis, and interpretation of data; or writing of the manuscript.

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