Exploring the Online Health Information Seeking Behavior of the Elderly and Testing the Emerging Model of Related Behavior Formation: An Exploratory Sequential Mixed-Methods Study

Abstract

English Abstract Background and Aim: Elderly people need different health information compared to other age groups since they experience age-related changes. The internet is a good source of information these people can use to seek for health information and self-care without leaving home. However, older people use internet for health information support less than other age groups. Therefore, in order to design a better online environment and enhance the chance of the elderly to get the most out of the internet, it seems necessary to understand how the online health information seeking behavior is formed in the elderly and what factors affect it. The present study aimed to discover the process of searching for online health information and test the emerging pattern of related behavior formation in the elderly people in Tabriz, Iran. Methods: The current exploratory sequential mixed-methods study was conducted in two qualitative and quantitative stages among the elderly people in Tabriz from 2018 to 2020. The first stage was a qualitative study with grounded theory method in which 19 elderly people with online health information search behavior, two children of the elderly people, one physician, one psychologist, four experts of elderly health, and one expert of health education were selected by purposeful and theoretical sampling method. In-depth individual interviews were used as the main method of data collection and Strauss and Corbin (2008) method was used for data analysis. In the second part of the study, through a cross-sectional study with a descriptive-analytical approach, we tested the grounded theory formed in the first stage from 2019 to 2020. At this stage, the data were collected through a multi-stage cluster sampling method and a researcher-made 96-item questionnaire answered by 320 elderly people from health centers, retirement centers, and parks in Tabriz. SPSS software version 23 and Mplus version 7.4 were used to analyze the data. Results: As a result of analyzing the qualitative phase, 5 main categories and 14 subcategories around a core concept were extracted. Analysis of semantic units and classes extracted from interviews showed that online health information search behavior in the elderly is a process in which the desire for healthy survival is a central category and dependency avoidance, seeking a reliable source of information, and motivators and inhibitors of using the internet were identified as the underlying factors of this behavior. The extracted actions and interactions are strategies for elderly self-reliance in their health care, and finally, the online health information seeking is the final outcome of the present study. The theory developed in the first phase of this study was ‘the desire for healthy survival: the use of self-reliance strategies in health care’. The results of testing this theory showed that among the demographic variables, educational status (high school diploma and lower), drug use, and having a history of surgery reduced the chance of online health information search behavior in the elderly by 86% (OR=0.14; CI=0.31-0.06), 94% (OR=0.06; CI=0.01-0.31), and 55% (OR=0.45; CI=0.24-0.82), respectively (P<0.05). Moreover, alcohol use increased the chances of behavior among participants by 6.28 times (OR=6.28; CI=1.90-20.77) (P<0.05). Examining the predictive effect of the variables of behavior formation, we found that the chances of online health information seeking behavior in the elderly is increased by 8% (OR=1.08; CI=1.02-1.15) in complete lack of trust in health care providers, by 19% (OR=1.19; CI=1.01-1.41) in complete certainty of obtaining reliable information, by 27% (OR=1.27; CI=1.07-1.49) in technology-dependent life, by 12% % (OR=1.12; CI=1.24-1.00) in internet benefits, and by 11% % (OR=1.11; CI=1.00-1.23) in self-efficacy of online information search. Meanwhile, internet inhibitors reduced the chances of this behavior by 15% % (OR=0.85; CI=0.91-0.78) (P<0.05). On the other hand, the results of the conceptual model (P=0.093), chi-square (26.287), RMSEA (0.038), as well as CFI (0.95) and TFI (0.91) provided a good fit for the structural equations of tendency to ‘healthy survival: self-reliance strategies in health care’. Conclusion: This study provides important insights for health care professionals and introduces some strategic implications for improving older people's access to appropriate health information. The online health information seeking model presented in this study is a potentially valuable tool for policymakers to take measures to support the elderly in need of self-care. Keywords: Information seeking, Health information, Internet, Elderly, Grounded theory