Developing a theoretical model to examine the antecedents to cyberchondria among Chinese Internet users

Abstract

Cyberchondria refers to a state in which a person experiences several behavioral, cognitive, and affective patterns, including excessive online health information seeking, along with distress, compulsion, and reassurance. As a nascent research area, limited research has explored the complex processes underlying how cyberchondria arises during online health information searches. Therefore, the purpose of this thesis was to develop a theoretical model to explicate the process of cyberchondria development and examine the antecedents to cyberchondria among Chinese Internet users. This doctoral thesis consists of three studies. Study One conducted a systematic review to summarize the measurements of cyberchondria as well as antecedents and consequences of cyberchondria, providing an overview of empirical research on cyberchondria. Next, informed by information management theories and the hybrid model of cyberchondria, this thesis proposed an integrative theoretical model, cyberchondria development model, to explain how individuals develop cyberchondria when searching for health-related information on the Internet. Study Two tested the applicability and validity of the cyberchondria development model on a sample of 426 Internet users in China using a cross-sectional online survey. Results of this study provided support to the process of cyberchondria development as depicted in the theoretical model, where perceived health threat of common symptoms can be a trigger of health anxiety, which motivates online health information seeking (OHIS) through the perception of information insufficiency, the gap between perceived current knowledge and sufficiency threshold. Additionally, source beliefs can strengthen the effect of information insufficiency on OHIS. Further, regular OHIS may result in cyberchondria, especially for people with negative metacognitive beliefs. Theoretical and practical implications of this study were discussed. To address the limitation of cross-sectional design in the previous study, Study Three conducted a three-wave longitudinal panel study to examine the cross-lagged effects of health anxiety, information insufficiency and OHIS on cyberchondria. Results showed that (a) health anxiety at Wave 1 had a cross-lagged effect on information insufficiency at Wave 2; (b) there was a reciprocal relationship between information insufficiency and OHIS from Wave 1 to Wave 2; (c) information insufficiency at Wave 1 increased OHIS at Wave 2, which further predicted cyberchondria at Wave 3; (d) OHIS at Wave 2 decreased health anxiety at Wave 3, while OHIS at Wave 2 increased cyberchondria at Wave 3; and (e) the three antecedents (i.e., health anxiety, information insufficiency, and OHIS) were directly and positively related to cyberchondria across the waves, except that information insufficiency at Wave 1 did not predict cyberchondria at Wave 2. In summary, this study further revealed the complex and dynamic processes underlying the development of cyberchondria. In conclusion, this thesis has addressed important research gaps in the existing cyberchondria literature and provided a more nuanced understanding of this new phenomenon in the digital age. It is hoped that the findings of this thesis can advance the field of cyberchondria research theoretically and practically, through conceptualizing cyberchondria as a multidimensional phenomenon, systematically summarizing the empirical landscape, developing an integrative theoretical framework, as well as empirically validating the framework using both cross-sectional and longitudinal designs.