Participation In Online Health Communities Research Articles

Participation In Online Health Communities: Decoding the antecedents and outcomes

A significant number (49 %) of Indian users tend to rely on digital media to either access health-related information or use the internet as a precursor to visit a doctor [20]. According to a report by Raheja [48], "The Internet of Things” (IoT) connection has the potential to change the malfunctioning medical system into a comprehensive, effective, and individualised system. This will allow for a more proactive approach to wellness and overall health, reducing medical expenses through these inclusive practices. Online health communities in India demonstrate significant clout to transform the healthcare industry by empowering patients. They offer a platform to all key stakeholders, that are, the healthcare professionals, patients and even the caregivers alike, to come forth, share their experiences and develop remedies for various issues faced by the healthcare industry. This paper examines the antecedents involved in the empowerment of patients in Online Health Communities (OHCs) and the outcomes of this in the form of participant compliance. The research additionally examines the moderating impact of certain factors such as the patients’ e-health literacy and health locus of control (HLOC) and the physicians’ paternalism, in examining the relationship between patient empowerment and compliance. The findings of the research propose a construct or a theoretical model for the numerous factors and moderators associated with the patient’s participation in online health communities. The social support available to patients leads to more empowered patients, ultimately resulting in higher Patient compliance. Further, this patient empowerment, which comprises of sense of autonomy, competence and self-efficacy makes people more compliant. The theoretical construct between patient empowerment and patient compliance, is further moderated by the patients’ e-health literacy and health locus of control (HLOC) and the physicians’ paternalism.

Sharing intention of electronic health records in online health communities: Patients' behavioral decisions in the context of privacy protection measures.

Online health communities (OHCs) have become more important to people's daily lives on the foundation of the voluntary sharing of electronic health records (EHRs). However, no in-depth investigation has been conducted concerning the influence of the perceptions of privacy protection among patients on their willingness to share EHRs. To fill the knowledge gap, by combining and modifying the theory of planned behavior (TPB) and the health belief model in the context of the privacy protection models implemented by OHCs, an empirical research method using a questionnaire approach is conducted to validate the hypotheses. The results indicate that the more positive a patient's attitude toward medical information sharing behavior is, the higher that patient's level of perceived behavioral control; in addition, the greater the social rewards obtained from this process, the more willing the patient is to share his or her EHRs after privacy protection measures are implemented by OHCs. Meanwhile, the effects of past positive experiences and disease severity have also been tested. The findings of this study can be used to promote patients' full participation in OHCs from a privacy perspective and offer theoretical and practical suggestions to promote the development of OHCs.

Online health communities and the patient-doctor relationship: An institutional logics perspective

Taking an institutional logics perspective, this study investigates how “internet-informed” patients manage tensions between the logic of personal choice and the logic of medical professionalism as they navigate treatment decisions and the patient-doctor relationship. Based on 44 semi-structured interviews with members of an online health community for people with diabetes, this study finds that patients exercise a great deal of agency in evaluating healthcare options not only by activating the logic of personal choice but also by appropriating the logic of medical professionalism. Furthermore, patients are strategic in deciding what community advice to share with their doctor or nurse depending on the healthcare professionals' reaction to the logic of personal choice. In contrast to many previous studies that emphasise patient consumerism fuelled by information on the Internet, this study provides a more nuanced picture of patient-doctor relationship engendered by patients’ participation in online health communities.

Communication strategies for older people in online health communities. The context of self-care

In a study based on biographical interviews with elderly people from rural areas (n = 30, Leningrad region) the roles and scenarios of using online communities of diseases are considered. Focusing on how the accumulation of knowledge about the treatment of diseases occurs in online communities, the work explores the communication and interactions of older people in online communities.Modern healthcare and the system of medical care are increasingly based on neoliberal principles. One of the ways to integrate illiberal methods of treating diseases is to create online disease communities where patients can get the necessary help from doctors and communicate with other patients, exchange experiences and receive advice on prescribing necessary medications. However, such communities are not accessible to everyone, and, consequently, there are difficulties with access to such a format for obtaining knowledge on the treatment of diseases in elderly patients, as well as in those patients who do not have access to the Internet. For elderly people with chronic diseases, such communities can serve as communities for communication, that is, those communities where communication is possible, which is often lacking for elderly people living in peripheral settlements. On the other hand, the importance of such communities is determined by the fact that it is often difficult for an elderly person in peripheral settlements due to remoteness to get the necessary advice or recommendation from a doctor, and communication in online communities and medical forums contributes to obtaining such advice, which is important in the treatment of the disease.In addition, participation in online health communities is useful for adapting to everyday life with a chronic disease and is defined as promoting the ability of patients to integrate into everyday life and society. On the other hand, in this study we focus on studying how the creation of knowledge about the treatment of diseases occurs within the framework of the participation of older people in online communities. Social communication, supported by online communities, facilitates the exchange of knowledge between elderly people with chronic diseases. This study contributes to the study of the possibilities and limitations of online communities in the context of living with chronic diseases of elderly people in rural areas.

Identifying Influences in Patient Decision-making Processes in Online Health Communities: Data Science Approach.

BackgroundIn recent years, an increasing number of users have joined online health communities (OHCs) to obtain information and seek support. Patients often look for information and suggestions to support their health care decision-making. It is important to understand patient decision-making processes and identify the influences that patients receive from OHCs.ObjectiveWe aimed to identify the posts in discussion threads that have influence on users who seek help in their decision-making.MethodsWe proposed a definition of influence relationship of posts in discussion threads. We then developed a framework and a deep learning model for identifying influence relationships. We leveraged the state-of-the-art text relevance measurement methods to generate sparse feature vectors to present text relevance. We modeled the probability of question and action presence in a post as dense features. We then used deep learning techniques to combine the sparse and dense features to learn the influence relationships.ResultsWe evaluated the proposed techniques on discussion threads from a popular cancer survivor OHC. The empirical evaluation demonstrated the effectiveness of our approach.ConclusionsIt is feasible to identify influence relationships in OHCs. Using the proposed techniques, a significant number of discussions on an OHC were identified to have had influence. Such discussions are more likely to affect user decision-making processes and engage users’ participation in OHCs. Studies on those discussions can help improve information quality, user engagement, and user experience.

What influences user participation in an online health community? The stimulus-organism-response model perspective

PurposeThe purpose of this paper is to understand the effect of platform characteristics (i.e. media richness and interactivity) on individual perception (i.e. outcome expectations) and consequent behavioral response (i.e. user participation in online health communities (OHCs)) based on the stimulus-organism-response (S-O-R) model.Design/methodology/approachThis study developed a research model to test the proposed hypotheses, and the proposed model was tested using partial least squares structural equation modeling (PLS-SEM) for which data were collected from 321 users with OHC experience using an online survey.FindingsThe empirical results show the following: (1) the three dimensions of media richness significantly affect the three outcome expectations, except that richness of expression has no significant effect on the outcome expectation of health self-management competence. (2) Human-to-human interaction significantly affects the three outcome expectations. Moreover, compared with human-to-human interaction, human-to-system interaction has a stronger impact on the outcome expectation of health self-management competence. (3) The three outcome expectations have a significant influence on user participation in OHCs.Originality/valueThis study extends the understanding about how platform characteristics (i.e. media richness and interactivity) motivate user participation in the context of OHCs. Drawing on the S-O-R model, this study reveals the underlying mechanisms by which media richness and interactivity are associated with outcome expectations and by which outcome expectations is associated with user participation in OHCs. This study enriches the literature on media richness, interactivity, outcome expectations and user participation in OHCs, providing insights for developers and administrators of OHCs.

Determining Factors Affecting the Users' Participation of Online Health Communities: An Integrated Framework of Social Capital and Social Support.

As the national awareness of health keeps deepening, online health communities (OHCs) have achieved rapid development. Users’ participation is critically important to the sustainable development of OHCs. Nevertheless, users usually lack the motive for participation. Based on the social capital theory, this research examines factors influencing users’ participation in OHCs. The purpose of this research is to find out decisive factors that influence users’ participation in OHCs, enrich the understanding of users’ participation in OHCs, and help OHCs address the issue of sustainable development. The research model was empirically tested using 1277 responses from an online survey conducted in China. Data was analyzed using the structural equation modeling (SEM). We found informational support and emotional support to have significant direct effects over the structural capital, relational capital and cognitive capital of OHCs. Meanwhile, it is observed that relational capital and cognitive capital degree have a significant influence on knowledge acquisition and knowledge contribution of OHCs. For researchers this study provides a basis for further refinement of individual models of users’ participation. For practitioners, understanding the social capital is crucial to users’ knowledge acquisition and knowledge contribution that achieve high participation in OHCs.

Unconscious or conscious? The impacts of habit and social support receipt on older adults' continued participation in online health communities

PurposeOnline health communities (OHCs) can be complementary to healthcare systems to improve the health behaviors of older adults with chronic diseases. This study aims to examine the impacts of habit and social support receipt on older adults' continued participation in OHCs. Particularly, the authors discussed the influences of social support received in two ways: social support received by initiating threads (direct social support receipt) and social support received by being exposed to the threads initiated by others (indirect social support receipt).Design/methodology/approachBased on the dual-process model (i.e. conscious process and unconscious process), the authors developed the research model. Data from one of the biggest online diabetes communities in Europe were collected. Besides, we used the support vector machine algorithm for social support classification and used the Cox proportion hazards model for model validation.FindingsOlder adults' continued participation is influenced by habit and indirect informational support. Habit moderates the relationship between direct informational support receipt and older adults' continued participation. Furthermore, direct and indirect emotional support receipt are both not associated with older adults' continued participation, regardless of their habit strength.Originality/valueThis is the first study investigating older adults' continued participation in OHCs based on the dual-process model. The findings of this study reveal that older adults' continued participation is determined by both the habit and specific conscious evaluation of benefits based on the social support receipt.

Patients' Perspective About the Cost of Diabetes Management: An Analysis of Online Health Communities.

ObjectiveTo understand the perspectives of persons’ living with diabetes about the increasing cost of diabetes management through an analysis of online health communities (OHCs) and the impact of persons’ participation in OHCs on their capacity and treatment burden.Patients and MethodsA qualitative study of 556 blog posts submitted between January 1, 2007 and December 31, 2017 to 4 diabetes social networking sites was conducted between March 2018 and July 2019. All posts were coded inductively using thematic analysis procedures. Eton’s Burden of Treatment Framework and Boehmer’s Theory of Patient Capacity directed triangulation of themes with existing theory.ResultsThree themes were identified: (1) cost barriers to care: participants describe individual and systemic cost barriers that inhibit prescribed therapy goals; (2) impact of financial cost on health: participants describe the financial effects of care on their physical and emotional health; and (3) saving strategies to overcome cost impact: participants discuss practical strategies that help them achieve therapy goals. Finally, we also identify that the use of OHCs serves to increase persons’ capacity with the potential to decrease treatment burden, ultimately improving mental and physical health.ConclusionHigh cost for diabetes care generated barriers that negatively affected physical health and emotional states. Participant-shared experiences in OHCs increased participants’ capacity to manage the burden. Potential solutions include cost-based shared decision-making tools and advocacy for policy change.

Interrelationship between Interpersonal Interaction Intensity and Health Self-Efficacy in People with Diabetes or Prediabetes on Online Diabetes Social Platforms: An In-Depth Survey in China.

Objective: The peer interaction–based online model has been influential in the recent development of diabetes management. This model “extends and innovates” the traditional mode of doctor–patient guidance, transforming it into a mode in which both doctor–patient guidance and patient–patient interaction coexist; this new mode has the added advantage of offering “extended continual intervention.” This study contributes to research on extending diabetes management models by investigating how patients with diabetes or prediabetes interact in online health communities, focusing on the interrelationship between self-efficacy characteristics and online participation during patient–patient interactions. Methods: In this cross-sectional study, participants with diabetes of various severities completed an electronic questionnaire, which was formulated with a revised classical scale. The questionnaire was disseminated through diabetes online health communities. Its content covered the respondent’s general condition, self-evaluation of their self-efficacy, and participation in online health communities, specifically with respect to factors such as the time spent in online information each day, the number of groups joined, and the extent of interaction in diabetes online health communities, etc. The main observation indicators were the participants’ self-efficacy, their extent of online participation, and the characteristics of online health communities. Descriptive statistics, chi-square test, linear trend estimation, and ordinal logistic regression were used to explore the relationship between the three indicators. Results: The self-efficacy scores ( ± s) were 51.9 ± 9.12, and 59.1% of interviewed participants had self-efficacy scores greater than the mean. Overall, most participants (96%) considered online diabetes social platforms to be helpful. Groups differed with respect to interaction mode, which indicated that people with high self-efficacy tend to employ various modes of interaction. Participants with high self-efficacy were also more likely to live in cities (p < 0.05) and be married (p < 0.05) and tended to spend more time paying attention to group information (p < 0.05), spend more time viewing group information (p < 0.05), and have a greater degree of interaction with group members (p < 0.05). Information sources for the different grades of participants was primarily obtained from social media. Conclusion: Among people with diabetes, the frequency and intensity of online interaction might positively affect self-efficacy and, by implication, diabetes self-management. Diabetics with high self-efficacy also tend to have positive online interaction and adopt different ways of interaction. In addition, the diabetes information sources of the respondents mainly come from social networks, most of the respondents think that online social networking sites have a positive impact on diabetes self-management, which shows that social network plays an important role in diabetes information source of diabetics. However, the design of online health communities has room for improvement, specifically with respect to the provision of information that patients require. As an interesting side note, among people with diabetes or prediabetes, those who lived in urban area and were married, those who paid more attention to group information, and those who actively participated in interactions tended to have relatively high self-efficacy. The results suggest that people with diabetes have higher-quality self-care when they engage in online health community interactions; such benefits cannot be obtained from treatment in a hospital. In general, enhanced self-efficacy in people with diabetes enables them to more readily acquire diabetes-related knowledge. Online interaction with diabetics, who has the same experience, can not only get more information, but also have a sense of identity and belonging, which enhances self-efficacy and further urges them to actively participate in online interaction. Therefore, online health communities are an important supplement to the clinical treatment of diabetes mellitus and clinicians can take advantage of the educational function of online diabetes groups in their provision of tailored diabetes interventions and take into account the factors that affect the self-efficacy of diabetics (including the frequency and intensity of online interaction, age, marital status, residential area, etc.), to provide tailored diabetes interventions for diabetics. Such a use of online diabetes groups can strengthen diabetes self-management.

Social Media in Occupational Health Nursing: Helpful or Harmful?

Background: Social media, an online vehicle for communication and media sharing, is a growing phenomenon in many aspects of everyday life, including health care. We explored the ways occupational health nurses can use social media as a helpful resource as well as identified potential concerns associated with its use. Methods: A review of the literature was conducted between December 1, 2019, and April 10, 2020, using PubMed and Google Scholar. Key search terms included social media, social network, nurse or nursing, occupational health, and online health. Criteria for selection included studies with results on social media within health care, nursing, and/or occupational health. Studies were also included if the health effects of social media were addressed. Six additional studies that had been previously identified by hand searching were included. Findings: These findings support the use of social media in occupational health for encouraging participatory health care among employees. Occupational health nurses can also utilize social media for health information, online health communities, emergency communication, health education workshops, professional connections, and continuing education. However, awareness of safe social media practice is necessary due to the possibility of misinformation and privacy breaches. Conclusion/Application to Practice: Social media can be used for education and communication with employees and is a way to support employees with specific health conditions through participation in online health communities . Occupational health nurses can take advantage of the speed and accessibility of social media to reach large numbers of employees. It is also a useful tool for addressing many health concerns encountered by employees; however, careful sourcing of information, awareness of company policies, and other safe practices can help to ensure it is helpful and not harmful.

Superusers' Engagement in Asthma Online Communities: Asynchronous Web-Based Interview Study.

BackgroundSuperusers, defined as the 1% of users who write a large number of posts, play critical roles in online health communities (OHCs), catalyzing engagement and influencing other users’ self-care. Their unique online behavior is key to sustaining activity in OHCs and making them flourish. Our previous work showed the presence of 20 to 30 superusers active on a weekly basis among 3345 users in the nationwide Asthma UK OHC and that the community would disintegrate if superusers were removed. Recruiting these highly skilled individuals for research purposes can be challenging, and little is known about superusers.ObjectiveThis study aimed to explore superusers’ motivation to actively engage in OHCs, the difficulties they may face, and their interactions with health care professionals (HCPs).MethodsAn asynchronous web-based structured interview study was conducted. Superusers of the Asthma UK OHC and Facebook groups were recruited through Asthma UK staff to pilot and subsequently complete the questionnaire. Open-ended questions were analyzed using content analysis.ResultsThere were 17 superusers recruited for the study (14 patients with asthma and 3 carers); the majority were female (15/17). The age range of participants was 18 to 75 years. They were active in OHCs for 1 to 6 years and spent between 1 and 20 hours per week reading and 1 and 3 hours per week writing posts. Superusers’ participation in OHCs was prompted by curiosity about asthma and its medical treatment and by the availability of spare time when they were off work due to asthma exacerbations or retired. Their engagement increased over time as participants furthered their familiarity with the OHCs and their knowledge of asthma and its self-management. Financial or social recognition of the superuser role was not important; their reward came from helping and interacting with others. According to the replies provided, they showed careful judgment to distinguish what can be dealt with through peer advice and what needs input from HCPs. Difficulties were encountered when dealing with misunderstandings about asthma and its treatment, patients not seeking advice from HCPs when needed, and miracle cures or dangerous ideas. Out of 17 participants, only 3 stated that their HCPs were aware of their engagement with OHCs. All superusers thought that HCPs should direct patients to OHCs, provided they are trusted and moderated. In addition, 9 users felt that HCPs themselves should take part in OHCs.ConclusionsSuperusers from a UK-wide online community are highly motivated, altruistic, and mostly female individuals who exhibit judgment about the complexity of coping with asthma and the limits of their advice. Engagement with OHCs satisfies their psychosocial needs. Future research should explore how to address their unmet needs, their interactions with HCPs, and the potential integration of OHCs in traditional healthcare.

Associations Between Engagement With an Online Health Community and Changes in Patient Activation and Health Care Utilization: Longitudinal Web-Based Survey.

BackgroundParticipation in online health communities (OHCs) is a popular trend in the United Kingdom. However, so far, no evidence exists to indicate an association between participation in OHCs and improved health outcomes.ObjectiveThis study aimed to (1) determine changes in patient activation over 3 months in new users of an OHC, (2) describe patterns of engagement with an OHC, (3) examine whether patients’ characteristics at baseline were associated with subsequent patterns of engagement, and (4) determine if patterns of engagement during the 3 months were associated with changes in patient activation, health care utilization, and health status.MethodsActive new OHC users on HealthUnlocked (HU) were surveyed to measure demographics, levels of patient activation (describing a person’s confidence in managing their own health; scale 0-100 with 4 categories), health care utilization, and health status using a Web-based survey at baseline and 3 months. Patient activation at baseline and 3 months was compared (aim 1). Alongside, for a sample of HU users and survey responders, daily OHC website usage data were automatically captured. This was used to identify clusters of engagement with HU (aim 2). For survey responders, baseline characteristics, patient activation, health care utilization, and health status were compared at baseline and 3 months, overall, and between engagement clusters using t tests and chi-square tests (aims 3 and 4).ResultsIn 329 people who completed both surveys, baseline activation was most frequently level 3, described as taking action but still lacking confidence. At follow-up, a change of 2.6 points was seen, with the greatest change seen in those at lowest baseline activation levels. In addition, 4 clusters of engagement were identified: low, medium, high, and very high, who were active on HU for a mean of 4, 12, 29, and 59 days, respectively. Survey responders were more commonly high or very high engagers. Baseline activation was highest in low and very high engagers. Overall activation increased over time in all engagement groups. Very high engagers had the greatest improvement in activation (5 points), although the average change was not above what is considered clinically meaningful for any group. Fewer accident and emergency visits were seen at follow-up in those with higher engagement, although this trend was not seen for other health care utilization measures. There was no change in health status at 3 months.ConclusionsThis observational study provides some insight into how patterns of engagement with OHCs are associated with changes in patient activation, health care utilization, and health status. Over 3 months, overall, the change in activation was not clinically significant, and there were some indications that OHCs may be of benefit to particular groups. However, the study limitations prevent firm conclusions about causal relationships.

Understanding users’ participation in online health communities: A social capital perspective

Due to the intense competition, it is crucial for online health communities to facilitate users’ participation and retain them. Drawing on the social capital theory, this research examined users’ participation in online health communities. The results indicated that social support, which includes informational support and emotional support, has a significant effect on social capital, which in turn affects users’ participation including health knowledge acquisition and contribution. The results imply that online health communities need to create a supportive climate in order to develop social capital and facilitate users’ participation.

Exploring the benefits and challenges of health professionals’ participation in online health communities: Emergence of (dis)empowerment processes and outcomes

BackgroundVarious online applications and service has led to the development of online health communities (OHCs), which in addition to the peer-to-peer communication offer patients and other users also interaction with health professionals. While the benefits and challenges of patients and other users’ participation in OHCs have been extensively studied, a thorough examination of how health professionals as moderators (i.e., those who provide clinical expertise to patients and other users in OHCs) experience participation in OHCs is lacking. ObjectiveThe aim of this study is to explore the main benefits and challenges of health professional moderators’ participation in the OHCs. MethodsThe study undertakes an exploratory qualitative study, with in-depth semi-structured interviews with health professional moderators (n=7) participating in the largest OHC in Slovenia, Med.Over.Net. The data was analysed using inductive thematic analysis approach and principles of grounded theory. ResultsFour themes of health professional moderators’ experiences were identified: (a) benefits of addressing OHC users’ health-related needs, (b) challenges of addressing OHC users’ health-related needs, (c) health professional moderators’ benefits, and (d) health professional moderators’ challenges. ConclusionsThis small study demonstrates that health professional participating in OHCs as moderators perceive themselves as facilitators of patients and other OHC’s users empowering processes and outcomes, in which OHC’s users improve their health literacy, develop skills, expand their social support, and gain other important resources necessary when dealing with health-related issues. Health professional moderator’s role, however, also involves several duties, responsibilities and limitations that are often experienced as difficulties in providing patients and other users with adequate counselling and online medical service. OHCs also represent an important terrain for personal and professional empowerment of health professional moderators, although the presence of disempowering processes also needs to be noted.

Can online buddies and bandwagon cues enhance user participation in online health communities?

Individuals are more likely to obtain information and support from online health communities than offer help to other users (Fox & Jones, 2009; Preece, Nonnecke, & Andrews, 2004). The current study attempts to resolve this problem of under-contribution by proposing two theory-based persuasive strategies—a specific request in the form of an online buddy and collective community feedback in the form of bandwagon cues. A 2 (online buddy: absence vs. presence) by 2 (bandwagon cues: weak vs. strong) between-participants experiment tested the effects of these strategies on psychological outcomes, including perceived responsibility, social presence, sense of community, and perceived helpfulness, as well as their posting attitudes, posting intentions, and website attitudes, across two sessions. Contrary to expectations, we found that the assignment of online buddies in a health community forum leads to negative psychological and behavioral consequences, especially in the absence of strong community feedback. Furthermore, the online buddy feature interacts with bandwagon cues to activate different cognitive processes, leading to differential interpretation of the meanings of those bandwagon cues—either as compliments (in the presence of online buddy) or as unreliable feedback (in the absence of online buddy). Theoretical and practical implications are discussed.

Features of Online Health Communities for Adolescents With Type 1 Diabetes

The aim of this exploratory study was to examine diabetes online health communities (OHCs) available to adolescents with type 1 diabetes (T1D). We sought to identify and classify site features and relate them to evidence-based processes for improving self-management. We reviewed 18 OHCs and identified the following five feature categories: social learning and networking, information, guidance, engagement, and personal health data sharing. While features that have been associated with improved self-management were present, such as social learning, results suggest that more guidance or structure would be helpful to ensure that those processes were focused on promoting positive beliefs and behaviors. Enhancing guidance-related features and structure to existing OHCs could provide greater opportunity for effective diabetes self-management support. To support clinical recommendations, more research is needed to quantitatively relate features and participation in OHCs to patient outcomes.

Informed citizen and empowered citizen in health: results from an European survey

BackgroundThe knowledge about the relationship between health-related activities on the Internet (i.e. informed citizens) and individuals' control over their own experiences of health or illness (i.e. empowered citizens) is valuable but scarce. In this paper, we investigate the correlation between four ways of using the Internet for information on health or illness and citizens attitudes and behaviours toward health professionals and health systems and establish the profile of empowered eHealth citizens in Europe.MethodsData was collected during April and May 2007 (N = 7022), through computer-assisted telephone interviews (CATI). Respondents from Denmark, Germany, Greece, Latvia, Norway, Poland and Portugal participated in the survey. The profiles were generated using logistic regressions and are based on: a) socio-demographic and health information, b) the level of use of health-related online services, c) the level of use of the Internet to get health information to decide whether to consult a health professional, prepare for a medical appointment and assess its outcome, and d) the impact of online health information on citizens' attitudes and behavior towards health professionals and health systems.ResultsCitizens using the Internet to decide whether to consult a health professional or to get a second opinion are likely to be frequent visitors of health sites, active participants of online health forums and recurrent buyers of medicines and other health related products online, while only infrequent epatients, visiting doctors they have never met face-to-face. Participation in online health communities seems to be related with more inquisitive and autonomous patients.ConclusionsThe profiles of empowered eHealth citizens in Europe are situational and country dependent. The number of Europeans using the Internet to get health information to help them deal with a consultation is raising and having access to online health information seems to be associated with growing number of inquisitive and self-reliant patients. Doctors are increasingly likely to experience consultations with knowledgeable and empowered patients, who will challenge them in various ways.