healthcare

Review
Online Health Information Seeking Behavior:
A Systematic Review
Xiaoyun Jia 1,2 , Yan Pang 3, * and Liangni Sally Liu 4

1 Business School, Foshan University, Foshan 528225, China; [Link]@[Link]

2 Massey University, Auckland 0632, New Zealand
3 Hunan Key Laboratory of Intelligent Logistics Technology, Central South University of Forestry and
Technology, Changsha 410004, China
4 School of Humanities, Media and Creative Communication, Massey University,
Auckland 0632, New Zealand; L.Liu2@[Link]
* Correspondence: pangyanzima@[Link]

Abstract: The last five years have seen a leap in the development of information technology and
social media. Seeking health information online has become popular. It has been widely accepted
that online health information seeking behavior has a positive impact on health information con-
sumers. Due to its importance, online health information seeking behavior has been investigated
from different aspects. However, there is lacking a systematic review that can integrate the findings
of the most recent research work in online health information seeking, and provide guidance to
governments, health organizations, and social media platforms on how to support and promote this
seeking behavior, and improve the services of online health information access and provision. We
therefore conduct this systematic review. The Google Scholar database was searched for existing
research on online health information seeking behavior between 2016 and 2021 to obtain the most




recent findings. Within the 97 papers searched, 20 met our inclusion criteria. Through a system-

 atic review, this paper identifies general behavioral patterns, and influencing factors such as age,
Citation: Jia, X.; Pang, Y.; Liu, L.S. gender, income, employment status, literacy (or education) level, country of origin and places of
Online Health Information Seeking residence, and caregiving role. Facilitators (i.e., the existence of online communities, the privacy
Behavior: A Systematic Review. feature, real-time interaction, and archived health information format), and barriers (i.e., low health
Healthcare 2021, 9, 1740. https:// literacy, limited accessibility and information retrieval skills, low reliable, deficient and elusive health
[Link]/10.3390/healthcare9121740 information, platform censorship, and lack of misinformation checks) to online health information
seeking behavior are also discovered.
Academic Editor: Tingshao Zhu

Keywords: online health information seeking behavior; online HISB; health information con-
Received: 31 October 2021
sumers; social
Accepted: 26 November 2021
Published: 16 December 2021

Publisher’s Note: MDPI stays neutral

1. Background
with regard to jurisdictional claims in
published maps and institutional affil-
With the proliferation of information and communication technology, utilizing the
iations. Internet to seek health information becomes a prevalent behavior [1–4]). Recently, seeking
health information online has become a preferred way due to its availability and cov-
erage of information, the convenience of searching, affordability of access, interactivity
and anonymity [5–8]. Online health information consumers can be patients and their
families/friends, and people who purposely seek health-related information online to
Copyright: © 2021 by the authors.
pursue good health or lifestyle [9,10]. Health information sought online includes “any-
Licensee MDPI, Basel, Switzerland.
This article is an open access article
thing regarding the symptoms, diagnoses, and treatments of different diseases or simply
distributed under the terms and
general information about weight loss, healthy diets or wellness tips” [11]. Seeking health
conditions of the Creative Commons information online allows health information consumers to obtain knowledge about their
Attribution (CC BY) license (https:// health issues, deal with health problems, and make health decisions, and have behavior
[Link]/licenses/by/ change [11,12].
4.0/).

Healthcare 2021, 9, 1740. [Link] [Link]

Healthcare 2021, 9, 1740 2 of 15

Online health information seeking behavior (HISB) has become a global trend [13].
There has been a continuous increase in online health information seeking activities
lately [6]. For example, a recent survey conducted in 2020 shows that generally, 55%
of Europeans aged 16–74 have sought health-related information online, with a 21% in-
crease since 2010 [14]. In particular, the percentage of online health information seeking
has reached over 70% in Finland, Netherlands, Denmark, and Germany [14]. The situation
in the US is similar. A recent study indicated that in 2008, 61.2% of the population sought
health information online first for their most recent search, while in 2017, the percent-
age had reached 74.4% [15]. In some Asian countries, the proportion of online health
information seeking behavior is even higher. For example, the percentages in mainland
China, Philippines, Hong Kong, Indonesia and Vietnam are 79%, 80%, 85%, 85% and 86%,
respectively [6,16].
Online health information seeking behavior is thought to have a positive influence on
health information consumers since they are more likely to better adhere to treatment after
obtaining adequate information of their health conditions [4,5,17]. Hence, understanding
online HISB is becoming increasingly important. Online HISB has been changing with
the development of information technology and social media, indicating that there might
exist significant differences between the health information of consumers’ previous online
HISB and the current one. Thus, it is essential to review the most recent academic papers
to have an overall up-to-date picture of online HISB research, provide timely and useful
guidance to governments, health organizations, media, and online platforms to support
and promote online HISB, and direct future studies.
We therefore conduct a systematic review on journal papers and top conference papers
published since 2016. The reasons we only review articles published in the last 5 years are
twofold. Firstly, it can make sure the findings of online HISB are up-to-date and instructive;
secondly, it can supplement the relevant findings of online HISB which reviewed articles
published before 2016 [18–20]. We ran a search in Google Scholar and chose journal articles
and top conference papers with an aim or a result about online HISB. Details of our selection
criteria are stated in Section 2.1. Among all the searched articles, after carefully reading
their titles and abstracts, we finally included and analyzed 20 articles in our review.
This review intends to integrate the most recent findings of research on online HISB. In
detail, the objectives of our review include (i) to discover the general characteristics of online
HISB; (ii) to identify factors that could influence online HISB; (iii) to find out the facilitators
and barriers to online HISB; (iv) to provide suggestions to health agencies/organizations
and social media platforms to support and promote online HISB, and improve their services
of online health information provision/access; and (v) to discuss the limitations of current
research and come up with suggestions for future studies and future research directions.
This review is organized as follows. Section 2 details the methods, including the search
and selection strategy. In Section 3, we present our integrated findings, and in Section 4,
we discuss the articles we reviewed and direct future studies.

2. Methods
2.1. Search Strategy
An electronic search was searched in August 2021 in Google Scholar with the combi-
nation of the following terms: “online” AND “health information seek*”. The asterisk (*)
was used to account for different variant forms such as “health information seeking” or
“health information seeker”. We decided to review papers published in the last five years
(since 2016) as social media has had a swift development in recent years. On the one hand,
only involving papers published recently ensures that the findings integrated into our
systematic review are up to date; on the other hand, it could avoid repetitive review work
on online HISB [18,20].
Healthcare 2021, 9, 1740 3 of 15

2.2. Inclusion and Exclusion Criteria

Full published papers which investigate health information consumers’ online HISB
were sought. The relevance was evaluated with the following criteria:
1. The article should (at least partially) have an aim or a result regarding health informa-
tion seeking;
2. The HISB should take place in an online environment. For example, the social
media platform.
The articles were excluded if they were satisfied any one of the following criteria:
1. The article focuses on the evaluation of the algorithm, search engines, or information
technology to improve online health information seeking;
2. The article is not written in English;
3. The article is not published in the peer-reviewed journals or top proceedings, such as
chapters or books;
4. The article is a review.
The selection process is shown in Figure 1.

Figure 1. The flowchart of records retrieved, removed, and included.

2.3. Selected Literature

The titles and abstracts of the searched articles were carefully read by investigators.
Based on the selection criteria as presented in Section 2.2, among 97 articles from the search
results, 20 final articles were confirmed to meet the selection criteria, while 77 articles were
eliminated from the review because 2 of them are review papers, 9 of them are not written
in English, 3 of them are about technology, system evaluation or algorithm, and the rest of
the papers are not related to online health information seeking behavior (HISB) or were
not published in the peer-reviewed journals or top proceedings.

3. Results
After thoroughly analyzing all the articles reviewed, we clustered and categorized the
findings based on themes. We presented our findings according to themes extracted from
the clustering analysis.
Healthcare 2021, 9, 1740 4 of 15

3.1. General Profile of the Reviewed Articles

Figure 2 depicts the number of final reviewed papers in online HISB published each
year since 2016. Table 1 summarizes the details of the articles reviewed, including research
design, methods used, sample sizes, targeted locations, and targeted subjects.
Healthcare 2021, 9, 1740 5 of 15

Table 1. The details of the articles reviewed.

Data Collection Subjects (Age

Authors Publication Year Title Journal Research Design Sample Number Location Data Analysis
Method Group/Sex/etc.)
Socio-cultural determinants of
Ukonu & Ajaebili, women’s health information Reproductive-age Descriptive and
2021 Asian Women Quantitative Survey n = 591 America
2021 [21] opportunities in Nsukka, women correlation analysis
southeast Nigeria
America & other
Exploring the factors in Participants with countries such as PLS-SEM (partial
information seeking behavior: a Health Promotion chronic obstructive New Zealand, least squares
Boyce et al., 2021 [22] 2021 Quantitative Survey n = 201
perspective from multinational International pulmonary disease Australia, South structural equation
COPD online forums (COPD). Africa, the UK, modeling)
Philippines, etc.
The relationship between health
HLRP: Health Descriptive and
Özkan et al., literacy level and media used as a
2021 Literacy Research Quantitative Survey n = 6228 Turkish citizen Turkey linear regression
2021 [23] source of health-related
and Practice analysis
information
Proceedings of the
2021 CHI
Online transgender health
Augustaitis et al., Conference on Online focus Trans and/or Inductive open
2021 information seeking: facilitators, Qualitative n = 26 America
2021 [24] Human Factors in groups nonbinary adults coding approach
barriers and future directions
Computing
Systems
Socio-demographic characteristics Health
Demirci et al.,
2021 affect health information seeking Information & Quantitative Survey n = 19,389 Turkish Turkey Logistic regression
2021 [25]
on the Internet in Turkey Libraries Journal.
Pearson’s correlation
Impact of smartphones on quality
Ghahramani & Information analysis, Preacher
2020 of life: a health information Quantitative Survey n = 3014 American adults America
Wang, 2020 [11] Systems Frontiers and Hayes Process
behavior perspective
macro
Adult residents in 34
Communication about health Indiana counties Descriptive statistics
Journal of General
Lee et al., 2020 [26] 2020 information technology use Quantitative Survey n = 970 with higher cancer America and multivariable
Internal Medicine
between patients and providers mortality rates than logistic regression
the state average
Journal of the Among mothers of
Which individual characteristics Korean Society for healthy infants and
Ordinal regression
Lee, 2020 [27] 2020 influence mothers’ health Library and Quantitative Survey n = 851 toddlers (currently America & Korea
analyzes
information-seeking behavior? Information living in the US
Science or Korea)
Explaining online health
Filipino female
information seeking of foreign
Bernadas & Jiang, Health and foreign domestic Multiple OLS
2019 domestic workers: a test of the Quantitative Survey n = 300 Hong Kong
2019 [28] Technology workers (WFDs) regression
comprehensive model of
in HK
information seeking
Factors influencing online health
Online Journal of Descriptive statistics,
Nangsangna & information seeking behavior Ghanaian residents
2019 Public Health Quantitative Survey n = 204 Ghana Chi-square test, and
Vroom, 2019 [17] among patients in Kwahu West who are over 16
Informatics logistic regression
Municipal, Nkawkaw, Ghana
Healthcare 2021, 9, 1740 6 of 15

Table 1. Cont.

Data Collection Subjects (Age

Authors Publication Year Title Journal Research Design Sample Number Location Data Analysis
Method Group/Sex/etc.)
Chinese patients
Why do patients follow physicians’ with health Structural equation
Zhang et al., advice? The influence of patients’ BMC Health information seeking modeling and
2019 Quantitative Survey n = 336 China
2019 [29] regulatory focus on adherence: An Services Research experience and confirmatory factor
empirical study in China hospital treatment analysis
experience
Health
LaValley et al., Where people look for online
2017 Information & Quantitative Survey n = 3959 American adults America Regression analysis
2017 [30] health information
Libraries Journal
Online health information seeking Advanced Science
Maon et al., 2017 [4] 2017 Quantitative Survey n = 482 Malaysian adults Malaysia Descriptive analysis
behavior pattern Letters
The Internet use for health International
Osei Asibey et al., information seeking among Journal of Ghanaian university
2017 Quantitative Survey n = 650 Ghana Descriptive analysis
2017 [5] Ghanaian university students: A Telemedicine and students
cross-sectional study Applications
The relationship of health literacy Journal of Public
Manganello et al., with use of digital technology for Health New York State
2017 Quantitative Survey n = 1350 America A weighted analysis
2017 [31] health information: implications Management and adult residents
for public health practice Practice
Health information seeking
Sultan et al., Khyber Medical Omani college Descriptive statistics
2017 behavior of college students in the Quantitative Survey n = 200 Oman
2017 [32] University Journal students (adults) and chi-square tests
sultanate of Oman
n = 3677
Seeking medical information using
[n = 2425 (family
mobile Apps and the Internet: Are Journal of Medical Multivariate logistic
Kim et al., 2017 [33] 2017 Quantitative Survey caregivers) n = American adults America
family caregivers different from Systems regression
1252 (Non-family
the general public?
caregivers)]
Analysis of barriers to health
Cross-Cultural
Xuexia et al., 2016 [9] 2016 information seeking and utilizing N/A N/A N/A N/A China N/A
Communication
in patients with diabetes
Online health information seeking Nigerian
Obasola &
2016 pattern among undergraduates in SAGE Open Quantitative Survey n = 400 undergraduate Nigeria Descriptive analysis
Agunbiade, 2016 [34]
a Nigerian University students
Descriptive statistics
Shneyderman et al., Health information seeking and Journal of Cancer
2016 Quantitative Survey Did not indicate American adults America and regression
2016 [35] cancer screening adherence rates Education
modeling
Healthcare 2021, 9, 1740 7 of 15

Figure 2. The number of reviewed papers since 2016.

3.2. The Identified Characteristics and Influencing Factors of Online Health Information
Seeking Behavior
3.2.1. General Behavioral Patterns of Online Health Information Seeking
Online health information seeking has been explored from different perspectives.
Overall, according to the reviewed literature, a large majority of the health information
consumers thought online health information was important, and online HISB had a
positive influence on their health [4,5]. Seventy-five percent of the health information
consumers believed the obtained online health information had either a minor or major
impact on them (or their families and friends) in their health treatment decision making,
overall health maintaining approach, and the way the health information consumers
thought about health-related issues [4].
Regarding the frequency of online HISB, over 60% of the health information consumers
sought at least on a weekly basis [4]. In particular, more than a quarter of the health
information consumers even searched online health information several times a day [4]. It
is also found that the frequency of Internet use could affect online HISB. Normally, regular
Internet consumers tended to have the habit of seeking health information online [11,25].
Additionally, smartphone users were more likely to search health-related information
online than regular cell phone users [11].
According to our review, 83% of the health information consumers searched health
information using a general search engine, such as Google and Yahoo, while 15% of the
online seekers tended to search on specific health information websites [4]. Social media
were more likely to be searched and used to address stress-related issues [21]. When
it comes to online health information seeking sources, health information consumers
mentioned social media platforms, user-generated online information sites such as Quora
and Reddit, and specialized health information websites, etc. [24].
As for the criteria for health websites, what the health information consumers valued
the most included (i) accuracy, (ii) currency of information, and (iii) ease of understand-
ing [4]. These selection criteria are consistent with those findings in a similar study [5].
Other criteria the health information consumers thought highly of, including “comprehen-
siveness, readability, confidentiality, interactivity, and quality of links to use of multimedia
and appearances,” [5].
The topics the health information consumers searched online are various. The most
popular searched topics included diet and nutrition, exercise and fitness, certain health
diseases, specific health treatment, mental health issues, and sexual/productive health
information, etc. [4,34].
As for the accessibility of online health information, most online health information
consumers believed they could find the information they wanted in their online searching,
and 78% of them reported their success rate of online health information seeking was
Healthcare 2021, 9, 1740 8 of 15

over 60% [4]. As for the reliability of the online health information sources, only 40% of
the surveyed health information consumers believed the online health information was
reliable [34]. So far, there have been no gender differences found regarding the perception
of accuracy of online health information sought [34]. Overall, more than 60% of the health
information consumers searched at least three different websites to locate and track health
information [4]. Interestingly, still, half of the health information consumers would consult
and confirm the health information they found online with health professionals [4].
Our systematic review shows that the reasons for seeking online health information
are diverse. Most health information consumers agreed that searching health information
online was convenient, anonymous and confidential, time-efficient, and that it was easy
to obtain instant up-to-date related information, etc. [4,5]. In addition, searching health
information online could give health information consumers the opportunities to seek out
sensitive health topics which they felt were hard to talk about in their daily life, obtain the
diagnosis of new health-related problems, and access comprehensive information to make
health decisions [4].

3.2.2. The Impact of Social and Demographic Factors on Online Health Information
Seeking Behavior
Generally age, gender, income, and employment status were found to significantly
influence online HISB [11,17,25,27]. According to our review, more women than men
were found to seek online health information [4,17,25]. Also, young adults were more
likely to seek online health information than senior ones [4,11,25]. There has been only
one contradictory finding showing that age was not significantly associated with online
HISB [17]. Regarding income, health information consumers with high income were more
likely to be online health information seekers [11]. Although employment status has been
confirmed to be an influencing factor, current research has not yet indicated how it impacts
online HISB [27].
In addition, literacy (or education) levels were believed to affect online HISB [17,25,27].
Health information consumers with a higher health literacy (or education) level reported a
higher percentage of online health information seeking. For example, in Ghana, nearly 70%
of the surveyed university students sought health information online and interacted with
health experts via social media platforms [5]. In Oman, the percentage of college students’
online HISB reached 89% [32]. Both data were significantly higher than those of the general
adults as mentioned above. Similarly, in Turkey, health information consumers with higher
literacy/education levels were found to seek online health information more frequently
than those with lower literacy (or education) levels [25]. Besides, health information
consumers with higher health literacy reported fewer difficulties (e.g., fewer effort to get
the information, less frustration with health information search, less concern about health
information quality, and fewer difficulties in understanding health information) with online
health information search than those with lower health literacy [31]. Moreover, health
information seeking sources also have an impact on health literacy. The existing research
shows that health information consumers who sought health information from the Internet
were found to have a higher health literacy level than those who sought health information
from other traditional sources such as newspapers and television [23].
Most studies confirmed that country of origin and place of residence also had an
impact on online HISB [25]. There were more online health information seekers in devel-
oped countries (or regions) than those in developing countries (or regions). For example,
in America, 63% of the surveyed adults reported they had online HISB [26]; in Turkey,
the percentage of online HISB was 48.6% [23] while in Ghana, this percentage was only
31.4% [17]. Another study conducted in Turkey also indicates that health information
consumers from developed regions sought online health information more frequently than
those from less-developed regions [25].
The caregiving role can also influence online HISB. Caregivers, compared with the
general public, were more likely to seek health-related information online [33]. Online HISB
among caregivers could even be used to predict the health of the family [33]. However,
Healthcare 2021, 9, 1740 9 of 15

some other social and demographic factors such as religion, marital status, and parental
status were not found to affect online HISB [17].
Furthermore, social and demographic characteristics were believed to be associated
with the searched health website type [30]. Young health information consumers were
found to prefer seeking health information from commercial websites, while senior health
information consumers tended to search from academic websites. In terms of gender,
women were more likely to seek health-related information from government websites.
Health information consumers with lower income were more likely to seek information
using the general search engines. Regarding ethnicity, Hispanic health information con-
sumers were more likely to seek health information using a general search engine compared
with their white counterparts [30].

3.2.3. Other Variables and Online Health Information Seeking Behavior

According to our review, factors initiating online HISB have been surveyed. The
top three factors were personal, family, and friend/peer sickness [32]. In addition, there
were some factors that could influence online HISB, including currency of information,
ease of understanding of health-related information, the accuracy of the information, and
content readability, etc. [5]. Prior research has also proposed different models to explore
the antecedents of online HISB. Four relevant models have been identified as follows:
Comprehensive model of information seeking (CMIS) has been widely used to inves-
tigate factors determining individuals’ information seeking behavior [36–38]. Bernadas
and Jiang [28] adopted CMIS and tested it in the online health context. They validated that
trustworthiness and tailorability of channels could positively influence online HISB. Here,
tailorability means “the degree to which a source makes it possible to acquire information
that is unique to one’s circumstance or situation” [39].
Based on regulatory focus theory, which suggests that health information consumers
with different regulatory focuses normally behave in different ways, Zhang et al. [29]
believe health information consumers in different focus states would seek different online
health information. They proposed a research model (as shown in Figure 3) and tested it in
health information consumers with two different focuses—promotion focus and prevention
focus [29]. Promotion focus was related to advancement, growth, and an aim of achieving
progress; while prevention focus was linked to security, safety, and an aim of avoidance
of mismatches [29]. They confirmed that: (1) online health information consumers with
promotion focus tended to have emerging treatment-related HISB; (2) those with prevention
focus tended to follow routines, and therefore have conservative treatment-related HISB;
(3) with the increase of media campaigns, the association between promotion focus and
emerging treatment-related HISB would be strengthened; (4) with the increase of website
reputation, the association between prevention focus and conservative treatment-related
HISB would be strengthened. Besides, patients’ conservative treatment-related HISB
with a prevention focus was validated to positively influence their adherence [29]. This
finding is similar to that of another study [35], indicating that online health information
seeking correlated with health (cancer) screening adherence. In general, people who sought
health-related information online were more likely to get screened on schedule [35]. In
comparison, emerging treatment-related HISB with a promotion focus was found to have
no relationship with health information consumers’ adherence [29].
Ghahramani and Wang [11] developed a research model exploring the impact of
smartphone uses on the quality of life from the perspective of online health information
behavior. Both health information seeking and tracking behavior was involved in the
proposed model. As we only review seeking behavior, the partial related model is relevant
and shown in Figure 4. Ghahramani and Wang [11] verified that the use of smartphones had
a positive effect on HISB. Moreover, age and caregiving roles could mediate the association
between smartphone use and HISB [11]. Young smartphone users and caregivers who
were smartphone users were more likely to seek health information online than senior and
non-caregivers smartphone users [11]. In addition, online HISB was confirmed to positively
Healthcare 2021, 9, 1740 10 of 15

affect the quality of life [11]. Online HISB could help health information consumers obtain
health knowledge, deal with health conditions, reduce pressure and stress caused because
of health problems, and therefore have a better life [11].

Figure 3. The research model of Zhang et al. [29]. In this model, health information consumers with different focuses were
found to seek different online health information.

Figure 4. The partial research model of Ghahramani and Wang [11]. In this model, online health information seeking
behavior was found to mediate the relationship between smartphone use and quality of life.

Boyce et al. [22] also proposed a research model (as shown in Figure 5) to explore the
factors influencing online HISB. They validated that perceived usefulness had a positive
influence on HISB, which is consistent with the findings of Ghahramani and Wang [11]. In
addition, perceived usefulness could mediate the relationship between perceived ease of
use and online HISB. Besides, the sense of self-worth was also confirmed to mediate the
relationship between perceived ease of use and online HISB.

Figure 5. The research model of Boyce et al. [22]. In this model, online health information seeking
behavior was found to be influenced by perceived usefulness, perceived ease of use and sense of
self-worth.

3.3. Facilitators and Barriers to Online Health Information Seeking

Facilitators of online health information seeking have been discussed by researchers.
First of all, online communities allow health information seekers to have a connection
and share information with specific health information consumers. Second, the privacy
feature online makes health information consumers feel safe to seek information. Third, the
Healthcare 2021, 9, 1740 11 of 15

synchronous function online allows health information consumers to interact in real-time

through online dialogue. By posting questions and receiving feedback, health information
consumers could obtain immediate health information required and make use of it. Addi-
tionally, online health information is always available in an archival format. Hence, health
information consumers can obtain enough information and access the knowledge even
posted in the past [24].
Barriers to seeking online health information in existing research have been analyzed
from consumer factors, health information factors, and platform factors [9,24]. Regarding
consumer factors, firstly, people with low health literacy may not even realize their need
to seek online health information. Secondly, health information consumers who are not
able to access the Internet, or with limited information retrieval skills may negatively affect
their online health information seeking as well [9].
In terms of health information factors, poor quality and low reliability of the online
health information (abundant misinformation) hinder health information consumers’ trust,
and therefore negatively influence their online seeking behavior [9,24]. In addition, the
content of online health information is not adequate to meet health information consumers’
demands. Some health-related information is still lacking, such as the knowledge of pre-
vention, and psychological and emotional guidance [9]. Furthermore, with the explosively
growing online health-related information, it is difficult for health information consumers
to quickly capture the information they require. In particular, some online health informa-
tion with medical jargon is hard for health information consumers to understand [9].
When it comes to platform factors, firstly, the platform censorship of the content and
identity makes health information consumers inconvenient to join online communities
where information is shared and exchanged between online members [24]. In addition,
lacking mechanisms of misinformation checks make it hard for health information con-
sumers to distinguish credible information from incorrect knowledge [24]. These two
factors were thought to have negatively affected online HISB [24].

3.4. Suggestions to Platforms, Health Organizations, and Governments

There are quite a few research papers which focus on providing suggestions to im-
prove online health information platforms, and services from governments and health
organizations. Thematically, we grouped these suggestions into three categories: (i) design
suggestions to online social media platforms, (ii) suggestions to health-related workers and
professionals, and (iii) suggestions to relevant health organizations and governments.
Design suggestions for social media platforms. Health information consumers’ ideal
platform has been investigated. Health information consumers indicated that their ideal
social media platform should be cleanly designed, easily navigated, and seem similar to
a blend of current existing platforms (e.g., YouTube and Twitter) with greater inclusivity
and accessibility for diverse identities and experiences [24]. Health information consumers
also mentioned some features they like: (1) platforms are expected to include a discussion
page where health information consumers could ask health-related questions and receive
answers from healthcare experts; (2) platforms should allow health information consumers
to set appropriate identity labels by providing more options. For example, allowing health
information consumers to have the opportunities to choose other sex types rather than the
binary choices of male and female; (3) platforms should emphasize privacy and security;
(4) platforms should consider content moderation balance to minimize false information
and encourage useful information exchange [24].
Suggestions to health-related workers and professionals. Health professionals can be
actively involved in motivating, assisting, and teaching their health information consumers
about health information seeking online [17]. For example, health experts can recommend
“provider-approved” online resources to the general public [30]). Website editors also
play an important role in disseminating health information online. They are supposed to
consult health experts to make sure the health-related information is accurate, readable,
and understandable before they publish it online [30].
Healthcare 2021, 9, 1740 12 of 15

Suggestions to governments and health organizations. Firstly, governments and health

organizations are expected to raise health awareness of the public. When the public are
aware of the importance of health, they are more likely to actively take part in their health
management [9].
Secondly, governments and health organizations are expected to design and improve
the construction of responsive websites/platforms and applications to increase the acces-
sibility of online healthcare and promote e-health [5,9]. An e-library is also expected to
be built to provide free and reliable online health-related information to the public at any
time [9].
Thirdly, online websites, platforms, and mobile healthcare applications should be
encouraged to use to improve health outcomes. Subsidies and other incentives from
governments and health organizations may be considered to promote their adoption [33].
In addition, online health-related information needs to be monitored, reviewed, and
assessed to ensure its accuracy, completeness, and consistency [25,33]. Governments and
health organizations may establish authoritative evaluation platforms to guarantee the
quality of the information [9]. Online health information also needs to be delivered through
proper media channels and platforms to fit health information consumers’ media utility
patterns [28].
Last but not least, more strategies need to be developed and evaluated to make
online health information more accessible and understandable, and make online health
information seeking easier [31]. In particular, health literacy needs to be taken into account
when governments and health organizations plan information seeking and dissemination
strategies [31]. The evolving technologies continuously generate new ways and channels for
health information delivery. Hence, health information consumers may have to constantly
learn new skills [31]. Governments and health organizations are expected to provide
training and support to improve health information consumers’ health literacy, especially
those with low health literacy [9,25]. In addition, more up-to-date research regarding new
strategies to improve health literacy, and health information dissemination and seeking
should be encouraged as well [31].

4. Discussion, Limitations, and Future Work

With the rapid growth of information technology and social media, online HISB has
been changing and evolving with time. In other words, the current online HISB of health
information consumers may be hugely different from that of ten years ago. Reviewing
articles published in the last five years ensures the findings of online HISB are up-to-
date, and therefore can provide timely and meaningful reference to governments, health
organizations, and media platforms.
Overall, most related findings on online HIBS published in the last five years are
consistent. This systematic literature review with integrated findings offers us a whole
picture regarding the general characteristics of online HISB, factors affecting online HISB,
and what governments, health organizations, and social media platforms should do to
provide better services to health information consumers. Methodologically, a majority of
the studies reviewed are quantitative and were conducted using a survey with a self-report
style [5,11,21–33,35]. Data collected through self-report may not represent the genuine
situation, thinking, or behavior of some health information consumers. Future studies may
consider adopting or triangulating other methods (e.g., observations) to counteract the
disadvantages of the method used [40,41] when investigating online HISB. Some data, such
as consumers’ online searching records, can be included to analyze online HISB as well.
From the perspective of the subjects, although the articles reviewed cover a wide range
of population, some specific groups of the population are lacking. The subjects of most
studies reviewed are general adults [4,11,24,25,30,31,35]. Participants also include univer-
sity students [5,32], trans or nonbinary adults [24], foreign workers [28], reproductive-age
women [21] and mothers [27], and patients with chronic disease [22]. Still, some specific
and relevant groups of the population have not been involved in online HISB, such as
Healthcare 2021, 9, 1740 13 of 15

children and adolescents, mental health patients, teachers, health educators, health workers
and professionals, and disabled users. Hence, future studies are expected to investigate
online HISB in different groups of subjects, and compare their online HISB.
The targeted locations of the studies reviewed include various countries including
America, China, Turkey, Ghana, Malaysia, Oman, Korea, and Nigeria, however there is still
a lack in a wide range of countries such as European countries and Latin American countries.
There is also a lack of comparison studies among countries with a similar economic
development level (e.g., American health consumers’ online HISB vs. Australian health
consumers’ online HISB), and among places with similar cultural backgrounds (e.g., online
health consumers’ information seeking behavior in mainland China vs. that in Hong Kong).
Future studies could conduct cross-country studies and compare behavioral similarities
and differences. As for the content, most studies reviewed only focus on investigating and
reporting the very basic characteristics of online HISB without providing deeper insights.
For example, some studies only surveyed the percentage of online HISB [23,26,30,34], only
providing the general and superficial understanding of online HISB. Future studies are
expected to design comprehensively and investigate online HISB in depth from different
aspects. Studies on facilitators and barriers are still limited and need to be investigated
further. Exploring facilitators and barriers is helpful to maintaining the good aspects which
are valued by health consumers, and to discover problems. Moreover, understanding
facilitators and barriers could help to come up with suggestions to governments, health
organizations, and health platforms. In particular, more strategies should be explored,
and detailed suggestions (e.g., technical side) need to be provided in future studies. On
the other hand, governments, health organizations, and health platforms should refer to
these strategies and create practical solutions to generate an open, safe and vibrant online
environment, make sure the online health information is correct and precise, and make
health information seeking easier, more accessible and efficient. For governments, health
organizations, and health platforms, the effective suggested solutions put forward based
on empirical studies should be applied in practice rather than only kept as suggestions
in the paper. This review is not without limitations. First of all, the search strategy may
miss out some related studies which were not identified in Google Scholar by searching the
keywords. Second, our standards of eligible articles may be different from others. Hence,
the findings may be different.

Author Contributions: Conceptualization, X.J; methodology, X.J.; validation, X.J., Y.P. and L.S.L.;
formal analysis, X.J.; investigation, X.J.; resources, X.J.; data curation, X.J.; writing—original draft
preparation, X.J.; writing—review and editing, Y.P. and L.S.L.; visualization, X.J.; supervision, Y.P.
and L.S.L.; project administration, Y.P.; funding acquisition, Y.P. and L.S.L. All authors have read and
agreed to the published version of the manuscript.
Funding: This research was funded by Hunan Key Laboratory of Intelligent Logistics Technology,
China (No. 2019TP1015); 2020 COVID-19 and Emerging Infectious Diseases, Health Research Council,
New Zealand (Ref ID: 20/985).
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Conflicts of Interest: Authors declare no conflict of interest.

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