Characterizing the Processes for Navigating Internet Health Information Using Real Time Observations: A Mixed Methods Approach
Background: Millions of Americans conduct regular health-related Internet searches. Little is known about the processes people use to find information or the individual characteristics that shape selection of information-seeking approaches. 

Objective: To describe how Internet users navigate the Internet for information about a hypothetical acute illness and to identify individual characteristics predictive of their information-seeking strategies. 

Participants: Study participants were recruited from public settings and agencies. Interested individuals were screened for eligibility using an online questionnaire. A person was eligible if s/he was 21–35 years of age, had searched the Internet for health information within the past 12 months, and reported access barriers to healthcare. 

Methods: Participants listened to one of two clinical scenarios. One was consistent with mild to moderate influenza, the other with bacterial meningitis. They were instructed to conduct an Internet search as though they were experiencing the symptoms presented in the scenario. Internet search mouse clicks and keystrokes, steps, were captured using screen-capture video software. Each step of the search was coded as hypothesis testing (etiology), exploration (symptoms), or action/treatment seeking (behavior). The coded steps formed a step-by-step pattern of each participant’s information-seeking process. We identified 26 unique patterns, which were grouped into four broad pattern classifications.

Results: Seventy-eight participants participated. Analysis proceeded in three steps. First, the patterns were put into a hierarchy of pattern classifications based on number of steps taken during the search (1 step = simple, >1 step = compound). Second, compound patterns were separated based on whether the pattern consisted of, both, developing a hypothesis and exploring symptoms (analytical) before ending the search or searching an action/treatment. Third, the patterns classified as analytical were further classified as including or not including action/treatment seeking. Using dual-processing theory, we categorized the four pattern classifications as either System 1 (41%, n=32) unconscious, rapid, automatic, and high capacity; or System 2 (59%, n=46), conscious, slow, and deliberative processing. Using multivariate regression, we found that System 2 processing was associated with higher education and younger age.

Conclusions: We identified and classified two approaches to processing Internet health information. System 2 processing, a methodical approach, most resembles the strategies for information processing that result in a high-quality decision. It is concluded that the quality of Internet health-information seeking could be improved through consumer education on methodical Internet navigation strategies and the incorporation of decision aides into health information websites. []