Mediating Effects of Perceived Quality of Healthcare Services on Patients' Consultations with Doctors about e-Health Information

Autonomous searching for healthcare information, participating in informed decision- making on healthcare options, and acquiring the knowledge and skills necessary to care for one’s own health are the ultimate goals of health empowerment. Internet-based health information technology (e-health) is considered to be a medium for health empowerment. However, there exist rising concerns about the quality of online health information (Anderson, 2004). Some online searchers even alter their treatment regimens or do not adhere to the treatment recommended by their physicians (Baker et al., 2003). Although e-health users are encouraged to consult doctors about the e-health information they found, only 53% of U.S. population self-diagnosed medical conditions via online consulted their physicians (Fox & Duggan, 2013). Previous studies have focused on individuals’ use of e-health tools and whether they consulted doctors about the information they found. However, few examined the path of how e-health users consult professionals about the information that they found.

 Although health empowerment is individually achieved, the process can be facilitated by healthcare professionals (Feste & Anderson, 1995). Hence, this study tested a hypothesis:

• Perceived quality of healthcare services play an indirect role between poor health and consultations with professionals about the information found online.

 Methods: The data were collected from the 2008 Health Information National Trends Survey. A subset of the sample contained Internet users (≥18) who first looked online for information about medical topics; used healthcare services during a year; and gave valid data. The subsample (N=2,297) was analyzed using structural equation modeling (SEM). Patients’ assessment of the quality of healthcare services was used as a mediator (M) since it encompasses the structural properties, the process and outcome of the treatment, and relational properties (Jackson, Chamberlin, & Kroenke, 2001). Patients’ self-assessed health and psychological distress (IV) were used to represent the health latent variable. Consultation about e-health information they found (DV) was binary.

 Results: The direct effect model (=‘c’) showed a positive and significant relationship between IV and DV (β=0.135, p=0.002). The relationship between IV and M (=a) was significantly and negatively associated (β=-0.466, p<0.001) while controlling for the predisposing factors’ effects. Path ‘b’ was tested and showed a significant and positive relationship between M and DV(β=0.092, p=0.004). Finally, the direct effect model was compared with the indirect model to test whether the total effect (=c) equaled the summation of the direct effect (=c′) and indirect effect (a*b). Plugging the standardized coefficients into the equation produced 0.133 which is approximately equal to the total effect c or 0.135, suggesting a complete mediation effect. The observed negative coefficient for path ‘a’ caused an increased coefficient for path ‘c,′ which is called a ‘competitive mediation’ effect (Zhao, Lynch, & Chen, 2010).

 Implications: The SEM analysis supported the hypothesized indirect model. The findings suggest that acknowledging patients’ perception of quality of health services is important when empowering e-health users to use e-health tools meaningfully. Professionals should acknowledge the importance of the quality services in their practice when consulting and planning health empowerment education.