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Patient Trust and Health Websites

Patient Trust and Health Websites

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Published by Laurian Vega
With the exploding growth of the web, health websites have become a dominant force in the realm of health care. Technically savvy patients have been using the web not only to self inform but to self diagnose. In this paper we examine the trust relationship between humans and health websites by outlining the existing literature on trust in health websites. A total of forty-nine papers were examined using a meta-analytical framework. Using this framework, each paper was coded for the antecedents and facets that comprise user trust in health websites. Our findings show that there is little consensus regarding the defining characteristics of the construct of trust in health websites. Further research in this field should focus on collaboratively defining trust and what factors affect trust in health web sites.
With the exploding growth of the web, health websites have become a dominant force in the realm of health care. Technically savvy patients have been using the web not only to self inform but to self diagnose. In this paper we examine the trust relationship between humans and health websites by outlining the existing literature on trust in health websites. A total of forty-nine papers were examined using a meta-analytical framework. Using this framework, each paper was coded for the antecedents and facets that comprise user trust in health websites. Our findings show that there is little consensus regarding the defining characteristics of the construct of trust in health websites. Further research in this field should focus on collaboratively defining trust and what factors affect trust in health web sites.

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Published by: Laurian Vega on Nov 27, 2011
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01/27/2013

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Trust between patients and health websites: areview of the literature and derived outcomesfrom empirical studies
Abstract
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With the exploding growth of the web, health websites have become a dominant force in the realm of health care. Technically savvy patients have been using the web not only to self inform but to self diagnose. In this paper we examine the trust relationship between humans and health websites by outlining the existing literature ontrust in health websites. A total of forty-nine papers were examined using a meta-analytical framework. Using thisframework, each paper was coded for the antecedents and facets that comprise user trust in health websites. Our findings show that there is little consensus regarding the defining characteristics of the construct of trust in healthwebsites. Further research in this field should focus on collaboratively defining trust and what factors affect trust inhealth web sites.Keywords: trust, empirical, e-health, website, internet, credibility, review, ontology
1. Introduction
Trust is foundational in relationships. In health care relationships, trust is critical: a patient trusts their care provider to give timely and appropriate care; a doctor trusts their patient to disclose correct information about their healthstatus; and care professionals trust each other to work coherently in regards to patient health. The increasing use of the internet creates another dimension to these relationships. A recent survey by the Pew Internet & American LifeProject found that 61% of Americans use the internet for health information (Fox and Jones, 2009). To try and take afirst look at this phenomenon, researchers have examined prior work on trust in technical systems (Corbitt et al.,2003, Eysenbach, 2001, Sharp et al., 2007). While past research makes insightful steps towards exploring therelationship between trust and technologies, it lacks the specificity of exploring trust in e-health systems, particularlyhealth websites.As health information technologies become more widespread, attention is turning to the factors that determinesuccessful adoption, acceptance, and appropriate use (Britto et al., 2009, Or and Karsh, 2009, Wilson and Lankton,2004). Currently trust is gaining the attention of those who design websites that contain medical information(Murray et al., 2004, Baker et al., 2003, Eysenbach et al., 2002) for some obvious reasons. Health is highly personal; for a user to adopt or use health technologies there is a need to assess the technology in an intimate way, part of this assessment involves trust. However, assessing the credibility of an e-health site has proven difficult. In areview of website evaluation tools, Breckons et al. (2008) concluded that such instruments, while attractive, are nota feasible option for measuring the reliability of health websites.To address the growing study and need for research on trust and health websites, we propose in this paper toreview prior work on user trust in health websites. Many definitions of trust interpret it by explaining whatconstructs trust encompasses. These encompassed constructs, or key elements of trust, are called facets. Examples of facets of trust include 'well-intentioned' (Theng and Soh, 2005), 'truthfulness' (Rains and Karmikel, 2009), and'integrity' (Zahedi and Song, 2008). Another tool used to help explain trust is an antecedent. An antecedent of trustshows factors that may cause trust variation. Examples of antecedents include 'relevance', 'authority', or 'disposition'(Kelton et al., 2008). Together, antecedents and facets of trust can help to model and define a user's trust wheninteracting with a website by demonstrating what affects trust and what user trust incorporates. Thus, our firstresearch question asks what facets and antecedents are used to explain trust in health websites.Our second research question aims to identify how user trust in health websites has been defined in theempirical literature. We have defined a health website as any webpage available either through an inter- or intranetwhere health information is available. Health websites were selected for examination due to their qualitative
 
 
difference in the types of stored information, the controversial application of aspects of trust being applied to trust inhealth websites, and the increased risk that is involved in using e-health information.Finally, our last research question studies the dialect of research on trust and health websites. Prior work hasfound that the multidisciplinary nature of this field has lead to a researchers not citing each other and found differentempirical outcomes (Vega et al., 2010). The parlance of discussing trust in health websites reflects the constructsfrom the multitude of fields that are used to study it. In essence, it reflects the antecedents and facets that are valued by different areas. For this reason, we ask what dialect is used to discuss trust and health websites.In this paper we couch the emerging research field of user trust in health websites within related broader work to present the value and need for this research. A review of all empirical studies of trust in health websites is presented in reference to the dialect, antecedents and facets, and definitions used. The findings discussed in this paper are then presented to represent a metaphorical “call to arms” for this research field.
2. Background & Related Work 
Research on user trust and health websites represents one part of the growing change in the health community astechnology use and patient agency evolve. To evaluate how research on user trust in health websites is situated, we present prior research of user trust in technology and e-health as they related to user trust in health websites.
2.1 Human-technology trust relationships
At a basic level, it can be argued that the study of trust in health is really a study of the relationship between humansand technology. For example, in one set of research, user trust was explored in automation technology by examininghow a particular automated system could influence subjects to trust or distrust the resultant automation (Lee andMoray, 1994, Muir, 1994, Parasuraman and Riley, 1997, Sheridan, 2002). This scholarship, however, does notsuccessfully represent the processes that patients as users undergo when forming trusting relationships with e-healthtechnologies. Specifically, the user values placed on the automation - such as 'reliable' or 'consistent' – are notnecessarily the pertinent ones that a user may value in an e-health system – such as 'dynamic' or 'personalized'.In another group of trust in technology research, investigators examined a user's trust in web-basedtechnologies, with a large portion of scholarship focusing on e-commerce and whether users would provide websiteswith personal information (Gefen and W., 2000, Daignault et al., 2002, Corbitt et al., 2003, McKnight et al., 2002,Grabner-Krauter and Kaluscha, 2003, Corritore et al., 2003). The scholarship involving trust between people andwebsites may serve as a useful model for patient and physician users of e-health technology, but it fails to accountfor the effects of technologies on the interpersonal patient-provider relationship – where trust in the provider has been linked to important quality indicators such as adherence, satisfaction, and improved health outcomes (Pearsonand Raeke, 2000, Anderson and Dedrick, 1990). Research on trust in technology represented an encompassingresearch area, but one that lacks important specificity.
2.2 Patient Trust in e-Health
Health websites represent one kind of e-health technology in an increasingly dispersed and complex network of health technologies that can have additionally varied effects on user trust. This is because health-related technologyhas become an important aspect of health consumerism that has branched into different aspects of patient life.Health information and services in an electronic format were primarily “informational” in the past; now patients canengage in many health-related activities electronically (Wilson et al., 2008). For example, patients can: view their health records online, view health information for family, interact with others with similar health concerns,communicate with care providers online, communicate with other non-providers about their health electronically,and search for information about their health symptoms and diagnoses, through a health website (Figure 1).
 
 
Figure 1. Patient e-health relationshipsThe added complexity of technology in health care adds new dimensions of risk, communication, and privacy.At the root of these constructs trust must be considered. In an e-health model the patient holds a great deal of power in their health care, which also gives them more entities to trust or distrust. Indeed, given the high value that isincreasingly being placed on patient-centered care, understanding the relationship to trust as a quality barrier toreaching these aims is paramount (Relman, 2001). Future research must address how patients negotiate informationfrom different sources, how their decisions affect the patient-provider relationship and important outcome variablessuch as patients adhering to advice, completing treatment plans, and seeking care when they need it rather than self diagnosis. A user’s trust in health websites is only one part of this interaction. In order to understand the broader need to evaluate user trust and e-health technologies, focusing on one domain is necessary.
2.3 Patient Trust in Health Websites
Research on user trust in health websites, as an instantiation of research on trust in technology and e-Health, hasdemonstrated important patient outcomes. With this fact in mind, we recognize that there are several definitions of what qualifies as a health website; we adopt the definition from Sillence et al. (2006) who identified 10 differenttypes of health websites: web portal sites, support groups, charity sites, government sites, pharmaceutical sites, salessites, personal sites, medical databases, media sites and clinician sites. Given the breadth of what qualifies as ahealth website, there is also a myriad of factors affecting a user’s trust, and how trust affects the use of healthwebsites. For instance, understanding the effects of the use of health technologies on patients’ perceptions of thequality of the care they receive and the effects on the doctor-patient relationship are important considerations for thedesign, implementation, and integration. Several studies show that, despite having access, some people choose not touse the internet for health information (Cotten and Gupta, 2004, Dolan et al., 2004). Trust has been identified as akey factor in determining which users will use the internet for health information and which will not (Dutta-Bergman, 2003, Rains, 2007).

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