Abstract
The World Wide Web provides an abundant source of medical information. This information can assist people who are not healthcare professionals to better understand health and illness, and to provide them with feasible explanations for symptoms. However, the Web has the potential to increase the anxieties of people who have little or no medical training, especially when Web search is employed as a diagnostic procedure. We use the term cyberchondria to refer to the unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web. We performed a large-scale, longitudinal, log-based study of how people search for medical information online, supported by a survey of 515 individuals' health-related search experiences. We focused on the extent to which common, likely innocuous symptoms can escalate into the review of content on serious, rare conditions that are linked to the common symptoms. Our results show that Web search engines have the potential to escalate medical concerns. We show that escalation is associated with the amount and distribution of medical content viewed by users, the presence of escalatory terminology in pages visited, and a user's predisposition to escalate versus to seek more reasonable explanations for ailments. We also demonstrate the persistence of postsession anxiety following escalations and the effect that such anxieties can have on interrupting user's activities across multiple sessions. Our findings underscore the potential costs and challenges of cyberchondria and suggest actionable design implications that hold opportunity for improving the search and navigation experience for people turning to the Web to interpret common symptoms.
- Agichtein, E., Brill, E., and Dumais, S. 2006. Improving Web search ranking by incorporating user behavior information. In Proceedings of the ACM SIGIR Conference on Research and Development in Information Retrieval. 19--26. Google ScholarDigital Library
- American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders 4th Ed. APA, Washington, DC.Google Scholar
- Asmundson, J. G., Taylor, S., and Cox, B. J. 2001. Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions. Wiley.Google Scholar
- Ayers, S. and Kronenfeld, J. 2007. Chronic illness and health-seeking information on the Internet. Health 11, 3, 327--347.Google ScholarCross Ref
- Baker, L., Wagner, T. H., Singer, S., and Bundorf, M. K. 2003. Use of the Internet and e-mail for health care information. J. Amer. Med. Assoc. 289, 18, 2401--2406.Google ScholarCross Ref
- Barsky, A. J. and Ahern, D. K. 2004. Cognitive behavioral therapy for hypochondriasis. J. Amer. Med. Assoc. 291, 12, 1464--1470.Google ScholarCross Ref
- Barsky, A. J. and Klerman, G. L. 1983. Overview: Hypochondriasis, bodily complaints, and somatic styles. Amer. J. Psychiatry 140, 273--283.Google ScholarCross Ref
- Benigeri, M. and Pluye, P. 2003. Shortcomings of health-related information on the Internet. Health Promot. Int. 18, 4, 381--387.Google ScholarCross Ref
- Berland, G. K., Elliott, M. N., Morales, L. S., Algazy, J. I., Kravitz, R. L., Broder, M. S., Kanouse, D. E., Muñoz, J. A., Puyol, J.-A., Marielena, L., Watkins, K. E., Yang, H., and Mcglynn, E. A. 2001. Health information on the Internet: Accessibility, quality, and readability in spanish and english. J. Amer. Med. Assoc. 285, 20, 2612--2621.Google ScholarCross Ref
- Bhavnani, S. K. 2002. Domain-Specific search strategies for the effective retrieval of healthcare and shopping information. In Proceedings of the ACM SIGCHI Conference on Human Factors in Computing Systems. 610--611. Google ScholarDigital Library
- Bhavnani, S. K., Jacob, R. T., Nardine, J., and Peck, F. A. 2003. Exploring the distribution of online healthcare information. In Proceedings of the ACM SIGCHI Conference on Human Factors in Computing Systems. 816--817. Google ScholarDigital Library
- Biermann, J. S., Golladay, G. J., Greenfield, M. L., and Baker, L. H. 1999. Evaluation of cancer information on the Internet. Cancer 86, 3, 381--390.Google ScholarCross Ref
- Cline, R. J. and Haynes, K. M. 2001. Consumer health information seeking on the Internet: The state of the art. Health Educ. Res. 16, 6, 671--692.Google ScholarCross Ref
- Czerwinski, M., Horvitz, E., and Wilhite, S. 2004. A diary study of task switching and interruptions. In Proceedings of the ACM SIGCHI Conference on Human Factors in Computing Systems. 175--182. Google ScholarDigital Library
- Downey, D., Dumais, S., and Horvitz, E. 2007. Models of searching and browsing: Languages, studies and application. In Proceedings of the International Joint Conference on Artificial Intelligence. 2740--2747. Google ScholarDigital Library
- Eastin, M. S. and Guinsler, N. M. 2006. Worried and wired: Effects of health anxiety on information-seeking and health care utilization behaviors. Cyberpsych. Behav. 9, 4, 494--498.Google ScholarCross Ref
- Elstein, A. S., Shulman, L. S., and Sprafka, S. A. 1978. Medical Problem Solving: An Analysis of Clinical Reasoning. Harvard University Press, Cambridge, MA.Google Scholar
- Eysenbach, G. 1998. Towards quality management of medical information on the Internet: Evaluation, labelling, and filtering of information. Brit. Med. J. 317, 1496--1502.Google ScholarCross Ref
- Eysenbach, G. and Kohler, C. 2002. How do consumers search for and appraise health information on the World Wide Web? Qualitative studies using focus groups, usability test, and in-depth interviews. Brit. Med. J. 324, 573--577.Google ScholarCross Ref
- Eysenbach, G., Powell, J., Kuss, O., and Sa, E.-R. 2002. Empirical studies assessing the quality of health information for consumers on the World Wide Web, A systematic review. J. Amer. Med. Assoc. 287, 20, 2691--2700.Google ScholarCross Ref
- Fleet, R. P., Dupuis, G., Marchand, A., Burelle, D., Arsenault, A., and Beitman, B. 1996. Panic disorder in emergency department chest pain patients: Prevalence, comorbidity, suicidal ideation, and physician recognition. Amer. J. Med. 101, 4, 371--380.Google ScholarCross Ref
- Heckerman, D. E., Horvitz, E. J., and Nathwani, B. N. 1992. Toward normative expert systems: Part I—The pathfinder project. Methods Inform. Med. 31, 90--105.Google ScholarCross Ref
- Hersh, W. R. and Hickam, D. H. 1998. How well do physicians use electronic information retrieval systems? A framework for investigation and systematic review. J. Amer. Med. Assoc. 280, 1347.Google ScholarCross Ref
- Hersh, W. R., Crabtree, M. K., Hickman, D. H., Sacherek, L., Friedman, C. P., Tidmarsh, P., Mosbaek, C., and Kraemer, D. 2002. Factors associated with success in searching MEDLINE and applying evidence to answer clinical questions. J. Amer. Med. Informatics Assoc. 9, 283--293.Google ScholarCross Ref
- Hu, F. B., Stampfer, M. J., Manson, J. E., Gordstein, F., Colditz, G. A., Speizer, F. E., and Willett, W. C. 2000. Trends in the incidence of coronary heart disease and changes in diet and lifestyle in women. New Eng. J. Med. 343, 8, 530--537.Google ScholarCross Ref
- Hufmann, J. C. and Pollack, M. H. 2003. Predicting panic disorder among patients with chest pain: An analysis of the literature. J. Amer. Med. Informatics Assoc. 9, 283--293.Google Scholar
- Hurst, W. 2002. The Heart, Arteries and Veins 10th Ed. McGraw Hill, New York.Google Scholar
- Ibqal, S. T. and Horvitz, E. 2007. Disruption and recovery of computing tasks: Field study, analysis, and directions. In Proceedings of the ACM SIGCHI Conference on Human Factors in Computing Systems. 677--686. Google ScholarDigital Library
- Jadad, A. R. and Gagliardi, A. 1998. Rating health information on the Internet: Navigating to knowledge or to Babel? J. Amer. Med. Assoc. 279, 8, 611--614.Google ScholarCross Ref
- Joachims, T., Granka, L., Pan, B., Hembrooke, H., and Gay, G. 2005. Accurately interpreting clickthrough data as implicit feedback. In Proceedings of the ACM SIGIR Conference on Research and Development in Information Retrieval. 154--161. Google ScholarDigital Library
- Kahneman, D., Slovic, P., and Tversky, A., Eds. 1982. Judgment Under Uncertainty: Heuristics and Biases. Cambridge University Press. Cambridge, UK.Google Scholar
- Kellner, R. 2001. Diagnosis and treatments of hypohondriacal syndromes. Pyschosomatics 33, 278--289.Google ScholarCross Ref
- Lewis, T. 2006. Seeking health information on the Internet: Lifestyle choice or bad attack of cyberchondria? Media, Cult. Soc. 28, 4, 521--539.Google Scholar
- Luo, G., Tang, C., Yang, H., and Wei, X. 2007. MedSearch: A specialized search engine for medical information. In Proceedings of the 16th Annual World Wide Web Conference. 1175--1176. Google ScholarDigital Library
- Nunnally, J. C. 1967. Psychometric Theory. McGraw Hill, New York.Google Scholar
- Ovsiankina, M. 1928. Die wiederaufnahme unterbrochener handlungen. Psychologische Forschung 11, 302--379.Google ScholarCross Ref
- PEW Internet and American Life Project. Online health search 2006. http://www.pewinternet.org/PPF/r/190/report_display.asp. (Accessed 9/07).Google Scholar
- Radlinski, F. and Joachims, T. 2005. Query chains: Learning to rank from implicit feedback. In Proceedings of the ACM SIGKDD Conference on Knowledge Discovery and Data Mining. 239--248. Google ScholarDigital Library
- Rosamond, W. D., Chambless, L. E., Folsom, A. F., Cooper, L. S., Conwill, D. E., Clegg, L., Wang, C., and Heiss, G. 1998. Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994. New Eng. J. Med. 339, 13, 861--867.Google ScholarCross Ref
- Shen, X., Dumais, S., and Horvitz, E. 2005. Analysis of topic dynamics in Web search. In Proceedings of the World Wide Web Conference. 1102--1103. Google ScholarDigital Library
- Sillence, E., Briggs, P., Fishwick, L., and Harris, P. 2004. Trust and mistrust of online health sites. In Proceedings of the ACM SIGCHI Conference on Human Factors in Computer Systems. 663--670. Google ScholarDigital Library
- Spink, A., Yang, Y., Jansen, J., Nykanen, P., Lorence, D. P., Ozmutlu, S., and Ozmutlu, H. C. 2004. A study of medical and health queries to Web search engines. Health Inform. Libr. J. 21, 44--51.Google ScholarCross Ref
- Tversky, A. and Kahneman, D. 1974. Judgment under uncertainty: Heuristics and biases. Sci. 185, 4157, 1124--1131.Google Scholar
- White, R. W. and Drucker, S. M. 2007. Investigating behavioral variability in Web search. In Proceedings of the World Wide Web Conference. 21--30. Google ScholarDigital Library
- Wildemuth, B. M. 2004. The effects of domain knowledge on search tactic formulation. J. Amer. Soc. Inform. Sci. Technol. 55, 3, 246--258. Google ScholarDigital Library
- Zeng, Q. T., Tse, T., Divita, G., Keselman, A., Crowell, J., Browne, A. C., Goryachev, S., and Ngo, L. 2007. Term identification methods for consumer health vocabulary development. J. Med. Internet Res. 9, 1, e4.Google ScholarCross Ref
Index Terms
- Cyberchondria: Studies of the escalation of medical concerns in Web search
Recommendations
Intentions and attention in exploratory health search
SIGIR '11: Proceedings of the 34th international ACM SIGIR conference on Research and development in Information RetrievalWe study information goals and patterns of attention in explorato-ry search for health information on the Web, reporting results of a large-scale log-based study. We examine search activity associated with the goal of diagnosing illness from symptoms ...
Captions and biases in diagnostic search
People frequently turn to the Web with the goal of diagnosing medical symptoms. Studies have shown that diagnostic search can often lead to anxiety about the possibility that symptoms are explained by the presence of rare, serious medical disorders, ...
Prevalence and Psychosocial Predictors of Cyberchondria in Nigeria During the COVID-19 Pandemic
The uncertainties surrounding the COVID-19 pandemic and frequently changing information about the virus heighten the potentials cyberchondria. This study investigated the prevalence and predictors of cyberchondria among Nigerians during the COVID-19 ...
Comments