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Importance: In most countries, young people with obsessive-compulsive disorder have limited access to specialist cognitive behavioral therapy (CBT), a first-line treatment.Objective: To investigate whether internet-delivered CBT implemented in a stepped-care model is noninferior to in-person CBT for pediatric obsessive-compulsive disorder.Design, Setting and Participants: A randomized clinical noninferiority trial conducted at 2 specialist child and adolescent mental health clinics in Sweden. Participants included 152 individuals aged 8 to 17 years with obsessive-compulsive disorder. Enrollment began in October 2017 and ended in May 2019. Follow-up ended in April 2020.Interventions: Participants randomized to the stepped-care group (n = 74) received internet-delivered CBT for 16 weeks. Nonresponders at the 3-month follow-up were then offered a course of traditional face-to-face treatment. Participants randomized to the control group (n = 78) immediately received in-person CBT for 16 weeks. Nonresponders at the 3-month follow-up received additional face-to-face treatment.Main Outcomes and Measures: The primary outcome was the masked assessor-rated Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score at the 6-month follow-up. The scale includes 10 items rated from 0 (no symptoms) to 4 (extreme symptoms), yielding a total score range of 0 to 40, with higher scores indicating greater severity. Assessors were masked to treatment allocation at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up assessments. The predefined noninferiority margin was 4 points on the CY-BOCS.Results: Among the 152 randomized participants (mean age, 13.4 years; 94 [62%] females), 151 (99%) completed the trial. At the 3-month follow-up, 34 participants (46%) in the stepped-care group and 23 (30%) in the in-person CBT group were nonresponders. At the 6-month follow-up, the CY-BOCS score was 11.57 points in the stepped-care group vs 10.57 points in the face-to-face treatment group, corresponding to an estimated mean difference of 0.91 points ([1-sided 97.5% CI, -∞ to 3.28]; P for noninferiority = .02). Increased anxiety (30%-36%) and depressive symptoms (20%-28%) were the most frequently reported adverse events in both groups. There were 2 unrelated serious adverse events (1 in each group).Conclusions and Relevance: Among children and adolescents with obsessive-compulsive disorder, treatment with an internet-delivered CBT program followed by in-person CBT if necessary compared with in-person CBT alone resulted in a noninferior difference in symptoms at the 6-month follow-up. Further research is needed to understand the durability and generalizability of these findings.Trial Registration: ClinicalTrials.gov Identifier: NCT03263546. [ABSTRACT FROM AUTHOR]

Background: Internet-based applications are potentially useful and effective interventions to reach and support adolescents with mental health problems. Adolescents' commitment to the use of a new Internet-based intervention is closely related to the support they receive from healthcare professionals. This study describes nurses' experiences of the use of an Internet-based support system for adolescents with depressive disorders.Method: Qualitative descriptive study design including individual interviews with nine nurses at two psychiatric outpatient clinics. The Technology Acceptance Model (TAM) was used as the theoretical background of the study.Results: Nurses described several benefits of using the Internet-based support system in the care of adolescents with depressive disorders if the nurses integrate it into daily nursing practices. As perceived disadvantages the nurses thought that an adolescent's mental status might be a barrier to working with the support system. Perceived enablers could be organizational support, nurses' attitudes, and technology-related factors. Nurses' attitudes were identified as a barrier to supporting adolescents' use of the Internet-based support system.Conclusion: The findings suggest that the implementation plan and support from the organization, including that from nurse managers, are crucial in the process of implementing a technology-based support system. [ABSTRACT FROM AUTHOR]

Abstract: The gradual transition of health care toward businesses during the past 50 years has converted passive patients into active customers. In our digital society, patients increasingly use online health communities to satisfy complex needs that healthcare professionals leave unmet, including the creation of cure‐oriented (i.e., functional) and care‐oriented (i.e., emotion) value. This research investigates patients’ reference frames (self versus other) as an information processing mechanism and their impact on value creation in online communities. The analysis of 1,687 online postings of a leading healthcare platform shows that self‐referencing is typical for information obtained through an individualistic, patient–doctor encounter; other‐referencing emerges when patients focus on the needs of their peers. Information gathered through the patient–doctor encounter and processed with a self‐referencing frame accordingly enhances cure‐related value, but limits care‐oriented value co‐creation. Other‐referencing does exactly the opposite: it creates a barrier to cure‐related value, but stimulates care‐related value. A patient's experience with the community largely moderates the impact of both self‐ and other‐referencing on cure‐ and care‐related value. These findings show that online health communities can identify and address unmet patient needs, but healthcare professionals still play a critical role in terms of ensuring information quality in online health communities. [ABSTRACT FROM AUTHOR]

Careful examination of communicative outcomes of mHealth technology is critical for understanding its capacity to shape the clinical interview and structure clinic communication. Drawing on a communicative affordances framework and adopting a video-based inductive analytic approach, we extend the concept of actualizations. We do so by examining the in situ communicative actions afforded by a mHealth web interface utilized during medication titration interviews with parents of children beginning stimulant medication for ADHD. We find that the web interface served five broad communicative functions that provided opportunities for improving information accuracy and for rendering clinical reasoning transparent, while jeopardizing opportunities for parents to narrativize medication experiences. We discuss clinical, theoretical, and methodological implications. [ABSTRACT FROM AUTHOR]

Medical healthcare is one of the fascinating applications using Internet of Things (IoTs). The pervasive smart environment in IoTs has the potential to monitor various human activities by deploying smart devices. In our pilot study, we look at narcolepsy, a disorder in which individuals lose the ability to regulate their sleep-wake cycle. An imbalance in the brain chemical called orexin makes the sleep pattern irregular. This sleep disorder in patients suffering from narcolepsy results in them experience irrepressible sleep episodes while performing daily routine activities. This study presents a novel method for detecting sleep attacks or sleepiness due to immune system attacks and affecting daily activities measured using the S-band sensing technique. The S-Band sensing technique is channel sensing based on frequency spectrum sensing using the orthogonal frequency division multiplexing transmission at a 2 to 4 GHz frequency range leveraging amplitude and calibrated phase information of different frequencies obtained using wireless devices such as card, and omni-directional antenna. Each human behavior induces a unique channel information (CI) signature contained in amplitude and phase information. By linearly transforming raw phase measurements into calibrated phase information, we ascertain phase coherence. Classification and validation of various human activities such as walking, sitting on a chair, push-ups, and narcolepsy sleep episodes are done using support vector machine, K-nearest neighbor, and random forest algorithms. The measurement and evaluation were carried out several times with classification values of accuracy, precision, recall, specificity, Kappa, and F-measure of more than 90% that were achieved when delineating sleep attacks. [ABSTRACT FROM AUTHOR]

People commonly use the Internet to search for health information and tend to use the information they find without regard to source or credibility. Although regulation plays some role in minimizing false claims made by manufacturers of self-help products, effective communication with health professionals likely offers greater protection to the patient or consumer accessing self-help materials. In order to best serve patients (or healthcare consumers), providers should educate them about their healthcare needs, inquire about self-help product use, understand appropriate use, discuss the risks and benefits of use, monitor the patients' condition during use, and document these conversations. Although some people fear that patient use of brain-themed self-help will undermine the doctor-patient relationship, it is more likely to open another avenue of communication if providers are knowledgeable about self-help products. Given the rise in importance of the Internet as a source of information for people, opting out of these discussions is realistically not an option. [ABSTRACT FROM AUTHOR]

Recently, healthcare services can be delivered effectively to patients anytime and anywhere using e-Health systems. e-Health systems are developed through Information and Communication Technologies (ICT) that involve sensors, mobiles, and web-based applications for the delivery of healthcare services and information. Remote healthcare is an important purpose of the e-Health system. Usually, the eHealth system includes heterogeneous sensors from diverse manufacturers producing data in different formats. Device interoperability and data normalization is a challenging task that needs research attention. Several solutions are proposed in the literature based on manual interpretation through explicit programming. However, programmatically implementing the interpretation of the data sender and data receiver in the e-Health system for the data transmission is counterproductive as modification will be required for each new device added into the system. In this paper, an e-Health system with the Semantic Sensor Network (SSN) is proposed to address the device interoperability issue. In the proposed system, we have used IETF YANG for modeling the semantic e-Health data to represent the information of e-Health sensors. This modeling scheme helps in provisioning semantic interoperability between devices and expressing the sensing data in a user-friendly manner. For this purpose, we have developed an ontology for e-Health data that supports different styles of data formats. The ontology is defined in YANG for provisioning semantic interpretation of sensing data in the system by constructing meta-models of e-Health sensors. The proposed approach assists in the auto-configuration of eHealth sensors and querying the sensor network with semantic interoperability support for the e-Health system. [ABSTRACT FROM AUTHOR]

Background: Informal or family caregivers are important contributors to health and health care and require support to sustain their role and address particular challenges. An experience-based health website may be an accessible, effective way to offer caregivers peer support and ultimately better equip them to care for themselves and their loved ones.Objectives: This study investigated how caregivers access and use information on the Internet about caregiving and their perspectives on the design and features of a new personal health experiences (PHEx) website.Methods: This was a qualitative descriptive study that involved three focus groups of caregivers for a total of 16 participants in a university-affiliated hospital in Quebec. Thematic analysis was used with transcriptions of recorded sessions.Results: With respect to how participants accessed and used health information, three themes emerged: searching for and choosing health websites, empowerment through the use of online health information, and concerns about health information on the Internet. In terms of their views on a health experiences website, the two main themes were: factors important for first impressions and perceived needs and expectations.Conclusion: Caregivers accessed and chose health information in a similar manner to other people but still offered additional insights regarding online health information retrieval, usage, and other perspectives, which will be helpful for future web-based initiatives that aim to provide support to caregivers. [ABSTRACT FROM AUTHOR]

Framing of causal interdependencies and uncertainties is important due to factors bringing change to healthcare, such as increasing access to healthcare information via the Internet and increasing self-care. In this paper, it is explained how critical realism can provide a basis for framing causal interdependencies and causal uncertainties within healthcare. The need for critical realist framing of causal interdependencies and uncertainties in healthcare is explained from the perspectives of human to human communication and human to AI communication. An example is provided of critical realist framing for causal interdependencies. Also, an example is provided of critical realist framing for causal uncertainties. Implications are discussed for human to human communication and human to AI communication. Critical realism can provide framing that is easy to grasp and recall. Importantly, critical realist framing can encompass both causal specificity and holistic overview when integrating diverse healthcare options. Moreover, critical realist framing can encompass uncertainties across the “why”, “how”, and “what” of healthcare. These characteristics of critical realist framing are important as end-users become increasingly aware of healthcare diversity and uncertainty. [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to improve the quality of diabetes control and evaluate the efficacy of an Internet-based integrated healthcare system for diabetes management and safety. Methods We conducted a large-scale, multi-centre, randomized clinical trial involving 484 patients. Patients in the intervention group ( n = 244) were treated with the Internet-based system for six months, while the control group ( n = 240) received the usual outpatient management over the same period. HbA1c, blood chemistries, anthropometric parameters, and adverse events were assessed at the beginning of the study, after three months, and the end of the study. Results There were no initial significant differences between the groups with respect to demographics and clinical parameters. Upon six-month follow-up, HbA1c levels were significantly decreased from 7.86 ± 0.69% to 7.55 ± 0.86% within the intervention group ( p < 0.001) compared to 7.81 ± 0.66% to 7.70 ± 0.88% within the control group. Postprandial glucose reduction was predominant. A subgroup with baseline HbA1c higher than 8% and good compliance achieved a reduction of HbA1c by 0.8 ± 1.05%. Glucose control and waist circumference reduction were more effective in females and subjects older than 40 years of age. There were no adverse events associated with the intervention. Discussion This e-healthcare system was effective for glucose control and body composition improvement without associated adverse events in a multi-centre trial. This system may be effective in improving diabetes control in the general population. [ABSTRACT FROM AUTHOR]

Background: Drug product data is available on the Web in a distributed fashion. The reasons lie within the regulatory domains, which exist on a national level. As a consequence, the drug data available on the Web are independently curated by national institutions from each country, leaving the data in varying languages, with a varying structure, granularity level and format, on different locations on the Web. Therefore, one of the main challenges in the realm of drug data is the consolidation and integration of large amounts of heterogeneous data into a comprehensive dataspace, for the purpose of developing data-driven applications. In recent years, the adoption of the Linked Data principles has enabled data publishers to provide structured data on the Web and contextually interlink them with other public datasets, effectively de-siloing them. Defining methodological guidelines and specialized tools for generating Linked Data in the drug domain, applicable on a global scale, is a crucial step to achieving the necessary levels of data consolidation and alignment needed for the development of a global dataset of drug product data. This dataset would then enable a myriad of new usage scenarios, which can, for instance, provide insight into the global availability of different drug categories in different parts of the world. Results: We developed a methodology and a set of tools which support the process of generating Linked Data in the drug domain. Using them, we generated the LinkedDrugs dataset by seamlessly transforming, consolidating and publishing high-quality, 5-star Linked Drug Data from twenty-three countries, containing over 248,000 drug products, over 99,000,000 RDF triples and over 278,000 links to generic drugs from the LOD Cloud. Using the linked nature of the dataset, we demonstrate its ability to support advanced usage scenarios in the drug domain. Conclusions: The process of generating the LinkedDrugs dataset demonstrates the applicability of the methodological guidelines and the supporting tools in transforming drug product data from various, independent and distributed sources, into a comprehensive Linked Drug Data dataset. The presented user-centric and analytical usage scenarios over the dataset show the advantages of having a de-siloed, consolidated and comprehensive dataspace of drug data available via the existing infrastructure of the Web. [ABSTRACT FROM AUTHOR]

Background: The adoption of healthcare technology is arduous, and it requires planning and implementation time. Healthcare organizations are vulnerable to modern trends and threats because it has not kept up with threats.Objective: The objective of this systematic review is to identify cybersecurity trends, including ransomware, and identify possible solutions by querying academic literature.Methods: The reviewers conducted three separate searches through the CINAHL and PubMed (MEDLINE) and the Nursing and Allied Health Source via ProQuest databases. Using key words with Boolean operators, database filters, and hand screening, we identified 31 articles that met the objective of the review.Results: The analysis of 31 articles showed the healthcare industry lags behind in security. Like other industries, healthcare should clearly define cybersecurity duties, establish clear procedures for upgrading software and handling a data breach, use VLANs and deauthentication and cloud-based computing, and to train their users not to open suspicious code.Conclusions: The healthcare industry is a prime target for medical information theft as it lags behind other leading industries in securing vital data. It is imperative that time and funding is invested in maintaining and ensuring the protection of healthcare technology and the confidentially of patient information from unauthorized access. [ABSTRACT FROM AUTHOR]

Objective: To develop a tool for measuring evidence-based practice (EBP) and to evaluate its content validity by Delphi technique. A five-factor/dimensions latent structure for the EBP construct was defined a priori and operationalized.Design: Online Delphi technique.Setting and Participants: A group of 32 national EBP experts from different health professions.Intervention: The experts rated the initial questionnaire items according to adequacy and relevance criteria using four-point Likert scales and including open fields for suggestions, with basic and supplementary criteria consensus established a priori.Main Outcome Measure: Level of consensus in the Content Validity Index Item.Results: An EBP construct solution was designed with the elements that constitute the operationalization proposal of the EBP. This initial version consisted of 76 items, whereas the version arising from the Delphi study was made up of 73 items. In the first round, 13 items did not reach the minimum level of consensus, and 12 of these were reformulated. Three additional items were removed in the second round.Conclusions: A new psychometric tool forms measuring EBP with a five-factor structure, and 73 items obtained adequate content validity evidence based on expert opinion. [ABSTRACT FROM AUTHOR]

Study Question: Does the prevalence of online education in fertility center websites differ for lesbian, gay, bisexual, transgender (LGBT) couples compared to online education for heterosexual couples?Summary Answer: This review of fertility center websites showed that the majority of websites with patient education for heterosexual couples do not have similar materials for LGBT couples.What Is Known Already: In order to have biologically related children, LGBT individuals or couples utilize assisted reproductive technologies (ART). Fertility clinic websites provide online education to familiarize patients with the different ART procedures; however, no studies have examined the prevalence of educational information for LGBT couples compared to information for heterosexual couples utilizing ART.Study Design, Size and Duration: This website review evaluated Centers for Disease Control and Prevention (CDC)-reported fertility center websites. Websites were reviewed in 2014 using the latest 2011 CDC report, and reviewed again in 2015 with the latest 2013 CDC report.Participants/materials, Setting, Method: Patient education information was coded using categories determined after a sample review, and differences were analyzed with χ(2) tests, with P-values calculated with Fisher's exact test.Main Results and the Role Of Chance: In 2014, 31.1% (121) of 389 websites with information for heterosexual couples also contained information for LGBT couples. In 2015, the number of fertility centers with information for LGBT couples increased by 52.9% to 185 (P < 0.001) of 407 (45.5%) fertility center websites. However, the majority of fertility clinic websites (54.5%) with information for heterosexual couples still do not include information specific to LGBT couples.Limitations, Reasons For Caution: The lack of online information on fertility center websites may not directly reflect the quality of care LGBT individuals or couples receive in the clinic, and the effect of this absence of online information on the clinical experiences of LGBT patients is unknown.Wider Implications Of the Findings: These findings add to the growing body of work showing disparities in the treatment of LGBT persons compared to the overall population. To overcome these discrepancies, healthcare providers should adapt their practice to include this growing and underserved patient population.Study Funding/competing Interests: Funding was provided by the Medical Student Summer Research Scholarship, Barbur Khalique Foundation. There are no competing interests. [ABSTRACT FROM AUTHOR]

Objective: Co-design information and website to support adolescents and young adults with long-term illnesses in their transition to adult healthcare.Methods: A participatory iterative process involving a survey (n=207), twenty-one interviews, six participatory workshops, six video recordings, two advisory groups, and a co-design group to identify needs and preferences for e-health and information provision, was used to develop an appropriate intervention.Results: Adolescents and young people expressed preferences for information that was trustworthy, empowering, colorful, easily downloaded online and written using non-patronizing language. They desired video testimonials of experiences from young adults who had transitioned to adult healthcare and wanted advice about becoming more independent, managing their condition, preparing for the transition, and information about medications and the differences between child and adult healthcare. They also wanted information about the location and configuration of adult healthcare, key hospital personnel, and frequently asked questions.Conclusion: The participatory iterative process led to the development of an online resource specifically tailored to the adolescents and young people's transition needs and information preferences. Preliminary feedback indicates that it is a valued resource.Practice Implications: The www.SteppingUP.ie website has the potential to help prepare its target population group for the transition to adult healthcare. [ABSTRACT FROM AUTHOR]

Background: In order to adapt to societal changes, healthcare systems need to switch from a disease orientation to a patient-centered approach. Virtual patient networks are a promising tool to favor this switch and much can be learned from the open and user innovation literature where the involvement of online user communities in the innovation process is well-documented. Objectives: The objectives of this study were 1) to describe the use of online communities as a tool to capture and harness innovative ideas of end users or consumers; and 2) to point to the potential value and challenges of these virtual platforms to function as a tool to inform and promote patient-centered care in the context of chronic health conditions. Methods: A scoping review was conducted. A total of seven databases were searched for scientific articles published in English between 1995 and 2014. The search strategy was refined through an iterative process. Results: A total of 144 studies were included in the review. Studies were coded inductively according to their research focus to identify groupings of papers. The first set of studies focused on the interplay of factors related to user roles, motivations, and behaviors that shape the innovation process within online communities. Studies of the second set examined the role of firms in online user innovation initiatives, identifying different organizational strategies and challenges. The third set of studies focused on the idea selection process and measures of success with respect to online user innovation initiatives. Finally, the findings from the review are presented in the light of the particularities and challenges discussed in current healthcare research. Conclusion: The present paper highlights the potential of virtual patient communities to inform and promote patient-centered care, describes the key challenges involved in this process, and makes recommendations on how to address them. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated thyroid cancer (TC) survivors' perceived satisfaction with and perceptions of survivorship care follow-up options.Methods: Well-differentiated TC (WDTC) patients receiving follow-up care at an academic cancer centre completed a questionnaire assessing perceived satisfaction with follow-up care involving different clinicians and mediated by the Internet (email or videoconference) and their perceptions of these follow-up options. We examined associations between patient characteristics and perceived satisfaction with follow-up care options. Qualitative responses were analysed using conventional content analysis.Results: Two hundred and two respondents completed the questionnaire (80 % response rate). The majority strongly agreed or agreed that they would be satisfied with specialist (surgeon, oncologist, or endocrinologist) follow-up (90.6 %) or a shared-care model that integrates specialists with primary care (67.5 %). One third (32 %) would be satisfied with video-based and 26 % with email-based specialist follow-up, 15 % with primary care alone. Longer time since diagnosis and health-related Internet use were associated with higher perceived satisfaction with Internet-based follow-up. Younger age was associated with higher perceived satisfaction with primary care follow-up. Qualitative responses (n = 145) revealed that survivors need reassurance they are receiving adequate care, regardless of the model or medium. Enablers to primary care and Internet-based follow-up are discussed.Conclusions: WDTC survivors want specialists involved in their follow-up. A specialist/primary care shared-care approach appears to be a suitable alternative to specialist-led follow-up for TC survivors. Internet-based visits could address some aspects of follow-up care for some WDTC survivors. Future work should examine patient and provider requirements for shared, multi-modal survivorship care. [ABSTRACT FROM AUTHOR]

This paper proposes a healthcare solution that enables the sharing of medical videos in areas without satellite, broadband or mobile internet connectivity. Rural areas often encounter issues such as shortage of electricity, poor telecommunication services and lack of health facilities which have led to a deficiency of medical care in remote areas. The deployment of mobile devices for healthcare services is vital to alleviating these concerns. A majority of mobile device owners are located in developing nations, and the number of users is continually rising. These technologies effectively support remote health care due to their low-power requirements, multiple functionalities and custom applications. The Mobile Imagery eXchange (MIX) toolkit is a software application capable of converting echocardiogram videos into text for transmission through short message service (SMS), over a global system for mobile communications network. A smartphone or computer installed with the MIX toolkit can be utilized to deliver effective medical care within rural regions. To significantly shrink data size, video, image and file processing techniques are applied for analysis, segmentation, compression and conversion. Experiments show that data size reduction rates above 60 until 95 % are achievable when transforming imagery into text. Furthermore, in optimal conditions, the average SMS per image ranges from 9 to 23 text messages. [ABSTRACT FROM AUTHOR]

Cloud computing brings several advantages such as flexibility, scalability, and ubiquity in terms of data acquisition, data storage, and data transmission. This can help remote healthcare among other applications in a great deal. This paper proposes a cloud based framework for speech enabling healthcare. In the proposed framework, the patients or any healthy person seeking for some medical assistance can send his/her request by speech commands. The commands are managed and processed in the cloud server. Any doctor with proper authentication can receive the request. By analyzing the request, the doctor can assist the patient or the person. This paper also proposes a new feature extraction technique, namely, interlaced derivative pattern (IDP), to automatic speech recognition (ASR) system to be deployed into the cloud server. The IDP exploits the relative Mel-filter bank coefficients along different neighborhood directions from the speech signal. Experimental results show that the proposed IDP-based ASR system performs reasonably well even when the speech is transmitted via smart phones. [ABSTRACT FROM AUTHOR]

Distributed m-healthcare cloud computing system significantly facilitates efficient patient treatment for medical consultation by sharing personal health information among healthcare providers. However, it brings about the challenge of keeping both the data confidentiality and patients’ identity privacy simultaneously. Many existing access control and anonymous authentication schemes cannot be straightforwardly exploited. To solve the problem, in this paper, a novel authorized accessible privacy model (AAPM) is established. Patients can authorize physicians by setting an access tree supporting flexible threshold predicates. Then, based on it, by devising a new technique of attribute-based designated verifier signature, a patient self-controllable multi-level privacy-preserving cooperative authentication scheme (PSMPA) realizing three levels of security and privacy requirement in distributed m-healthcare cloud computing system is proposed. The directly authorized physicians, the indirectly authorized physicians and the unauthorized persons in medical consultation can respectively decipher the personal health information and/or verify patients’ identities by satisfying the access tree with their own attribute sets. Finally, the formal security proof and simulation results illustrate our scheme can resist various kinds of attacks and far outperforms the previous ones in terms of computational, communication and storage overhead. [ABSTRACT FROM PUBLISHER]

There is a general need for high-quality, easily accessible, and comprehensive health-care information on epilepsy to better inform the general population about this highly stigmatized neurological disorder. The aim of this study was to evaluate the health literacy level of eight popular English-written websites that provide information on epilepsy in quantitative terms of readability. Educational epilepsy material on these websites, including 41 Wikipedia articles, were analyzed for their overall level of readability and the corresponding academic grade level needed to comprehend the published texts on the first reading. The Flesch Reading Ease (FRE) was used to assess ease of comprehension while the Gunning Fog Index, Coleman–Liau Index, Flesch–Kincaid Grade Level, Automated Readability Index, and Simple Measure of Gobbledygook scales estimated the corresponding academic grade level needed for comprehension. The average readability of websites yielded results indicative of a difficult-to-fairly-difficult readability level (FRE results: 44.0 ± 8.2), with text readability corresponding to an 11th academic grade level (11.3 ± 1.9). The average FRE score of the Wikipedia articles was indicative of a difficult readability level (25.6 ± 9.5), with the other readability scales yielding results corresponding to a 14th grade level (14.3 ± 1.7). Popular websites providing information on epilepsy, including Wikipedia, often demonstrate a low level of readability. This can be ameliorated by increasing access to clear and concise online information on epilepsy and health in general. Short “basic” summaries targeted to patients and nonmedical users should be added to articles published in specialist websites and Wikipedia to ease readability. [ABSTRACT FROM AUTHOR]

Background: Although the increasing dissemination and use of health-related information on the Internet has the potential to empower citizens and patients, several studies have detected disparities in the use of online health information. This is due to several factors. So far, only a few studies have examined the impact of socio-economic status (SES) on health information seeking on the Internet. This study was designed to identify sociodemographic and health-(care-)related differences between users and non-users of health information gleaned from the Internet with the aim of detecting hard-to-reach target groups. Methods: This study analyzed data from the NRW Health Survey LZG.NRW 2011 (n = 2,000; conducted in North Rhine-Westphalia, Germany, via telephone interviews). Logistic regression analysis was used to examine the determinants of online health information seeking behavior. Results: 68% of Internet users refer to the Internet for health-related purposes. Of the independent variables tested, SES proved to exert the strongest influence on searching the Internet for health information. The final multivariate regression model shows that people from the middle (OR: 2.2, 95% CI: 1.6-3.2) and upper (OR: 4.0, 95% CI: 2.7-6.2) social classes are more likely to seek health information on the Internet than those from the lower class. Also, women are more likely to look for health information on the Internet than men (OR: 1.5, 95% CI: 1.1-2.1). Individuals with a migration background are less likely to conduct health searches on the Internet (OR: 0.6, 95% CI: 0.4-0.8). Married people or individuals in a stable relationship search the Internet more often for health information than do singles (OR: 1.9, 95% CI: 1.2-2.9). Also, heavy use of health-care services compared to non-use is associated with a higher likelihood of using the Internet for health-related matters (OR: 1.7, 95% CI: 1.2-2.5). Conclusions: In order to achieve equity in health, health-related Internet use by the socially deprived should be promoted through measures to increase their level of e-health literacy. Furthermore, longitudinal studies are needed in order to gain reliable data/results on determinants of health-related Internet use. [ABSTRACT FROM AUTHOR]

Compared with the traditional model of health service, internet health service has distinct advantages, promising future in the 21st century. But whether the medical service can satisfy users' requirements and whether the service those websites provide can be useful and reliable? We need objectively analyze the current situation in China. This paper employs Technology Acceptance Model (TAM) to analyze users' perception of medical websites and their attitude toward using. After systematically summarizing and analyzing the theories and empirical studies of formal researchers, the author has adjusted TAM according to the practical situation of Chinese internet health service and introduced factors which influenced users' perceived usefulness and perceived ease of use as external variables into this model and thereby set up the theoretical framework of this paper. Different from former researches conducted from the perspective of technical development of internet health service, this paper carries out a relatively systematic analysis of user requirements and service level of internet health service and reaches conclusions which accord with expectations. [ABSTRACT FROM AUTHOR]

Objective Many Internet users seek health information through online health communities (OHCs) and other social media. Yet few studies assess how individuals use peer-generated health information, and many healthcare providers (HCPs) believe OHCs interfere with patient–provider relationships. This study explored how individuals use OHC content in clinical discussions and how HCPs react to it. Methods We conducted in-person and virtual focus groups with patients/caregivers who visited OHCs ( n = 89). A trained moderator asked about reasons for membership, sharing OHC content with providers, HCP reactions, and preferred roles for HCPs. Two researchers independently coded verbatim transcripts (NVivo 9.2) and conducted thematic response analysis. Results Participants described OHCs as supplementing information from HCPs, whom they perceived as too busy for detailed discussions. Almost all participants shared OHC content with HCPs, although only half cited OHCs as the source. Most HCPs reacted negatively to OHC content, making participants feel disempowered. Despite these reactions, participants continued to use OHCs, and most desired HCP feedback on the accuracy of OHC content. Conclusions Individuals do not use OHCs to circumvent HCPs but instead to gather more in-depth information. Practice implications HCPs should discuss OHC content with patients to help them avoid misinformation and make more informed decisions. [ABSTRACT FROM AUTHOR]

Background: Effective management of hypertension in chronic kidney disease and renal transplantation is a clinical priority and has societal implications in terms of preserving and optimizing the value of scarce organs. However, hypertension is optimally managed in only 37% of people with chronic kidney disease, and poor control can contribute to premature graft loss in renal transplant recipients. This article describes a telehealth system that incorporates home electronic blood pressure (BP) monitoring and uploading to a patient portal coupled with a Web-based dashboard that enables clinical pharmacist collaborative care in a renal transplant clinic. Materials and Methods: The telehealth system was developed and implemented as a quality improvement initiative in a renal transplant clinic in a large, 700-bed, urban hospital with the aim of improving BP in posttransplant patients. A convenience sample of 66 posttransplant patients was recruited by the clinical pharmacist from consecutive referrals to the Transplant Clinic. Results: Preliminary results show statistically significant reductions in average systolic and diastolic BP of 6.0 mm Hg and 3.0 mm Hg, respectively, at 30 days after enrollment. Two case reports describe the instrumental role of home BP monitoring in the context of medication therapy management. Conclusions: Optimizing BP control for both pre- and post-renal transplant patients is likely to benefit society in terms of preserving scarce resources and reducing healthcare costs due to premature graft failure. Connected health systems hold great promise for supporting team-based care and improved health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the proportion of patients in Qassim Province, Saudi Arabia, who use the Internet to search for health-related information, determine barriers to Internet use, and investigate the relationship between Internet use and socio-demographic variables. Methods: A total of 377 questionnaires were distributed to five main hospitals in Qassim Province (Saudi Arabia). The patients were randomly selected to complete the survey when they arrived to fill their pharmacy prescription. The survey was explained to the patients, and they were given the option to participate or decline. Results: Fifteen percent of the respondents used the Internet as a source of health-related information, especially disease-specific information (97.7 %). Thirty percent used the Internet after a recommendation from their health-care provider. The highest proportions of respondents indicated that lack of training and the cost of Internet access were major barriers to Internet use. There was a significant association between Internet use and education level (p = 0.002). Conclusion: Compared with published data for Qassim City, Saudi Arabia, Internet use to obtain health-related information is relatively low in the Qassim Province, Saudi Arabia. Lack of training is the most common barrier. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To study whether demographic and smoking-related characteristics are associated with participation (reach) in a smoking cessation trial and subsequent use (uptake) of two specific smoking interventions (Internet-based program and proactive telephone counseling). Methods: We used data from a four-arm randomized smoking cessation trial (2011). Participants (n =1,809) were recruited among 9,924 smokers who previously participated in two health surveys in Denmark (2007–2008 and 2010). Interventions were as follows: (1) an Internet-based smoking cessation program, (2) proactive telephone counseling, (3) reactive telephone counseling and (4) a self-help booklet. Results: Reach (defined as the proportion accepting to participate in the trial of those invited) was highest among persons aged 40–59years, women, heavy smokers and persons with long education. Among trial participants, uptake (defined as any use of the specific intervention at 1-month follow-up) was 69% for the Internet-based program, 74% and 9% for proactive and reactive telephone counseling, respectively, and 84% for the self-help booklet. Young age was associated with the uptake of the Internet-based program, and short education was associated with using proactive telephone counseling. Conclusions: Internet-based interventions and proactive telephone counseling appeal to different age and educational groups. Further, offering similar intervention content by a proactive and a reactive approach can be associated with different intervention uptake. [Copyright &y& Elsevier]

Computing plays an important role in all aspects of achieving and maintaining health and well-being. Exploiting health information technology for decreasing cost and errors is increasingly supported by government and academia in the US and abroad. This special issue includes four examples of recent innovative projects in the realm of smart and connected health. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Prostate cancer patients, as well as their caregivers and healthcare providers, often search the Internet for information about treatment options. We aimed to assess how accurate and up-to-date information about prostate cancer treatments is on websites owned and managed by health-related organizations that most patients and health care providers would consider to be the most trustworthy, based on the reputations of the site providers. Materials and methods: We reviewed 43 noncommercial and easily found websites that offered extensive information on treatment options for prostate cancer patients. To assess how comprehensive the sites were, we focused on the information they provided on alternative hormonal therapies to commonly prescribed luteinizing hormone-releasing hormone (LHRH) agonists, namely GnRH antagonists and parenteral estradiol. Results: Only 14 of 43 websites presented GnRH antagonists as a therapy option for prostate cancer. Sixteen of these 43 websites presented estrogen as a possible treatment option, but only 1 of the 43 websites contained current information on parenteral estrogen treatments. Less than half of the sites provided time stamps indicating when they were last updated. Furthermore, most sites with time stamps were not in fact up-to-date based on the information posted on the site. Conclusions: Few seemingly reputable Internet sources for medical information provide viewers with the detailed and up-to-date information that they may expect from such sites when searching for alternatives to standard treatment for androgen suppression. Strategies for keeping such websites up-to-date and reliable are discussed. Sites may improve their credibility and usefulness if they (1) present all evidence-based treatment options, (2) regularly update and time stamp their information, (3) acknowledge that their recommendations on treatments may become out-of-date quickly, (4) and direct viewers to information on relevant, active clinical trials. Maintaining high quality sites may ultimately depend on users taking the initiative to inform website owners when their sites are out-of-date. [Copyright &y& Elsevier]

Background: In South Africa, stigma, discrimination, social visibility and fear of loss of confidentiality impede health facility-based HIV testing. With 50% of adults having ever tested for HIV in their lifetime, private, alternative testing options are urgently needed. Non-invasive, oral self-tests offer a potential for a confidential, unsupervised HIV self-testing option, but global data are limited. Methods: A pilot cross-sectional study was conducted from January to June 2012 in health care workers based at the University of Cape Town, South Africa. An innovative, unsupervised, self-testing strategy was evaluated for feasibility; defined as completion of self-testing process (i.e., self test conduct, interpretation and linkage). An oral point-of-care HIV test, an Internet and paper-based self-test HIV applications, and mobile phones were synergized to create an unsupervised strategy. Self-tests were additionally confirmed with rapid tests on site and laboratory tests. Of 270 health care workers (18 years and above, of unknown HIV status approached), 251 consented for participation. Findings: Overall, about 91% participants rated a positive experience with the strategy. Of 251 participants, 126 evaluated the Internet and 125 the paper-based application successfully; completion rate of 99.2%. All sero-positives were linked to treatment (completion rate:100% (95% CI, 66.0–100). About half of sero-negatives were offered counselling on mobile phones; completion rate: 44.6% (95% CI, 38.0–51.0). A majority of participants (78.1%) were females, aged 18–24 years (61.4%). Nine participants were found sero-positive after confirmatory tests (prevalence 3.6% 95% CI, 1.8–6.9). Six of nine positive self-tests were accurately interpreted; sensitivity: 66.7% (95% CI, 30.9–91.0); specificity:100% (95% CI, 98.1–100). Interpretation: Our unsupervised self-testing strategy was feasible to operationalize in health care workers in South Africa. Linkages were successfully operationalized with mobile phones in all sero-positives and about half of the sero-negatives sought post-test counselling. Controlled trials and implementation research studies are needed before a scale-up is considered. [ABSTRACT FROM AUTHOR]

Background: A health technology assessment (HTA) of catheter ablation for atrial fibrillation (CA-AF) was commissioned by the Belgian government and performed by the Belgian Health Care Knowledge Centre (KCE). In this context, a systematic review of the economic literature was performed to assess the procedure's value for money. Methods: A systematic search for economic literature about the cost-effectiveness of CA-AF was performed by consulting various databases: CRD (Centre for Reviews and Dissemination) HTA and CDSR (Cochrane Database of Systematic Reviews) Technology Assessment, websites of HTA institutes, NHS EED (NHS Economic Evaluation Database), Medline (OVID), EMBASE and EconLit. No time or language restrictions were imposed and pre-defined selection criteria were used. The two-step selection procedure was performed by two persons. References of the selected studies were checked for additional relevant citations. Results: Out of 697 references, seven relevant studies were selected. Based on current evidence and economic considerations, the rationale to support catheter ablation as first-line treatment was lacking. The economic evaluations for second-line catheter ablation included several assumptions that make the results rather optimistic or subject to large uncertainty. First, overall AAD (antiarrhythmic drugs) use after ablation was higher in reality than assumed in the economic evaluations, which had its impact on costs and effects. Second, several models focused on the impact of ablation on preventing stroke. This was questionable because there was no direct hard evidence from RCTs to support this assumption. An indirect impact through stroke on mortality should also be regarded with caution. Furthermore, all models included an impact on quality of life (QoL)/utility and assumed a long-term impact. Unfortunately, none of the RCTs measured QoL with a generic utility instrument and information on the long-term impact on both mortality and QoL was lacking. Conclusions: Catheter ablation is associated with high initial costs and may lead to life-threatening complications. Its cost-effectiveness depends on the belief one places on the impact on utility and/or preventing stroke, and the duration of these effects. Having no hard evidence for these important variables is rather troublesome. Although the technique is widely spread, the scientific evidence is insufficient for drawing conclusions about the intervention's cost-effectiveness. [ABSTRACT FROM AUTHOR]

The Internet has become a major source of health information for the general public and has the potential to influence health behaviours; however, most people lack the knowledge and skills to use it insightfully. This paper reports on the evaluation of a community education program, in which a team of clinicians and consumer representatives from a large metropolitan hospital partnered with a major public library to provide free interactive workshops for the general public. The aim of the workshops was to improve participants' ability to find and use evidence-based health information on the Internet. The aim of the evaluation reported here was to study participation in and impact of these workshops. Researchers administered pre- and post-workshop surveys to 89 members of the general public who participated in a workshop. This study found not only similarities in participants' pre-workshop use of online health information compared with population-level studies but also some interesting differences. The workshop was found to have an overall positive impact on changing the way participants intended to look for and use health information in the future, and on improving their knowledge about evidence-based health information, with 63.5% of respondents stating that they would use health information in the future to ask a doctor new questions. These findings offer important evidence of the need to plan nuanced health literacy education and information strategies for the general public. [ABSTRACT FROM AUTHOR]

To determine the one-month prevalence of the seeking of web-based health information in the general adult population and to identify the symptoms associated with more frequent searching for information online. This was an observational cross-sectional study in a representative sample of 1,002 randomly selected Slovenian inhabitants. We used the method of computer-assisted telephone interviews. The questionnaire consisted of demographic questions, questions about the prevalence and duration of pre-selected symptoms in the past month, questions on the presence of chronic disease and a question about using the Internet for seeking health advice in the past month. Among 774 respondents who reported having had symptoms in the past month, 25.8% of them reported seeking health information on the Internet. The factors found to be independently associated with the seeking of health information on the Internet were a younger age, a higher education level and the presence of constipation, irritability, fatigue, memory impairment and excessive sweating in the past month. The study showed that the Internet was a common source of health information in the general adult population, particularly used for symptoms which are common but not well defined and not associated with a particular disease. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate patients’ and health professionals’ (a) motives and use of social media for health-related reasons, and (b) barriers and expectations for health-related social media use. Methods: We conducted a descriptive online survey among 139 patients and 153 health care professionals in obstetrics and gynecology. In this survey, we asked the respondents about their motives and use of social network sites (SNS: Facebook and Hyves), Twitter, LinkedIn, and YouTube. Results: Results showed that patients primarily used Twitter (59.9%), especially for increasing knowledge and exchanging advice and Facebook (52.3%), particularly for social support and exchanging advice. Professionals primarily used LinkedIn (70.7%) and Twitter (51.2%), for communication with their colleagues and marketing reasons. Patients’ main barriers for social media use were privacy concerns and unreliability of the information. Professionals’ main barriers were inefficiency and lack of skills. Both patients and professionals expected future social media use, provided that they can choose their time of social media usage. Conclusion: The results indicate disconcordance in patients’ and professionals’ motives and use of social media in health care. Practice implications: Future studies on social media use in health care should not disregard participants’ underlying motives, barriers and expectations regarding the (non)use of social media. [Copyright &y& Elsevier]

Background: In Vietnam, men who have sex with men (MSM) are highly affected by HIV and need new targeted HIV prevention strategies. Objectives: To assess the willingness to use the Internet to seek information on HIV prevention and care and associated factors among MSM in Ho Chi Minh City. Methods: A descriptive cross-sectional study was conducted in 2012. Participants were recruited using a convenience sampling method in venues most frequented by MSM and completed a self-administered questionnaire. Logistic regression models were performed to estimate factors associated with the willingness to use the Internet to seek information on HIV prevention and care. Results: A total of 358 MSM were approached for the survey and 222 questionnaires (62.0%) were eligible for analyses. Overall, 76.1% of the respondents reported that they were willing to use the Internet to seek information on HIV prevention and care. A number of male partners in last year less than or equal to 3 (Adjusted Odds Ratio: 3.07, 95% Confidence interval: 1.40–6.73), a history of STI screening (4.10, 1.02–16.48) and HIV testing (3.23, 1.20–8.64) and having ever sought a male sexual partner through the Internet (3.56, 1.55–8.18) were significantly positively associated with the willingness to use the Internet to seek information on HIV prevention and care. Conclusion: The MSM interviewed in Ho Chi Minh City reported a high willingness to use the Internet to seek information on HIV prevention and care. In a context where new media are increasingly considered as promising options for reaching this HIV risk group, further research should be conducted on developing and testing tailored online tools adapted to the needs of Vietnamese MSM. [ABSTRACT FROM AUTHOR]

There has been an increased use of modern information and communication technology in healthcare services in recent years; however, little is yet known about the nature of the therapeutic alliance in internet-based interventions. This review aims to give a systematic overview of controlled evaluation studies with a focus on the nature and impact of the therapeutic alliance in internet-based interventions available to date. The results of internet-based randomized controlled trials indicate that a positive therapeutic alliance can be established regardless of the medium of communication. The therapeutic alliance was rated equally satisfying as in conventional face-to-face therapy. [ABSTRACT FROM AUTHOR]

Purpose: There is growing recognition that many physician-patient encounters do not require face-to-face contact. The availability of secure Internet portals creates the opportunity for online eVisits. Increasing numbers of health systems provide eVisits, and many health plans reimburse for eVisits. However, little is known on who chooses to seek care via an eVisit. Materials and Methods: At four primary care practices, we used the electronic medical record to identify all eVisits and office visits for sinusitis and urinary tract infections (UTIs) between January 2010 and May 2011. From the electronic medical record we abstracted the necessary information on patient demographics. The population studied included 5,165 sinusitis visits (9% of which were eVisits) and 2,954 UTI visits (3% eVisits). Results: In multivariate models controlling for other patient factors, the variables most strongly associated with a patient initiating an eVisit versus an office visit were age (18-44 years of age versus 65 years of age and older: sinusitis, odds ratio 1.65 [0.97-2.81]; UTI, 2.97 [1.03-8.62]) and longer travel distance to clinic (>10 miles from patient home to clinic versus 0-5 miles: sinusitis, odds ratio 6.54 [4.68-9.16]; UTI, odds ratio 3.25 [1.74-6.07]). Higher income was not associated with higher eVisit use. Conclusions: At these four primary care practices, eVisits accounted for almost 7% of visits for sinusitis and UTI. eVisits attract a younger patient population who might use eVisits for convenience reasons. [ABSTRACT FROM AUTHOR]

Background: Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access. Method: We undertook a review of the social science and public health literature pertaining to HCV treatment for PWID, with a focus on barriers to treatment access, uptake and completion. Medline and Scopus databases were searched, supplemented by manual and grey literature searches. A two step search was taken, with the first step pertaining to literature on HCV treatment for PWID and the second focusing on social structural factors. In total, 596 references were screened, with 165 articles and reports selected to inform the review. Results: Clinical and individual level barriers to HCV treatment among PWID are well evidenced. These include patient and provider concerns regarding co-morbidities, adherence, and side effect management. Social factors affecting treatment access are less well evidenced. In attempting to map these, key barriers fall into the following domains: social stigma, housing, criminalisation, health care systems, and gender. Key facilitating factors to treatment access include: combination intervention approaches encompassing social as well as biomedical interventions, low threshold access to opiate substitution therapy, and integrated delivery of multidisciplinary care. Conclusion: Combination intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. Future research needs to better delineate social factors affecting treatment access. [ABSTRACT FROM AUTHOR]

Background: The use of the Internet for searching and sharing health information and for health care interactions may have a great potential for families of children affected with rare diseases. We conducted an online survey among Italian families of patients with rare diseases with the objective to describe their Internet user profile, and to explore how Internet use affects their health decisions. Methods: All members of UNIAMIO FIMR, a federation of associations of patients with rare diseases, were invited via mail to participate in an online questionnaire including questions on socio-demographic and clinical information, Internet use with a specific focus on health, and impact of web information on health behaviors. Logistic regression models were used to explore the effect of socio-demographic variables and Internet user profile on dependent variables representing the impact of web information on health behaviors. Multiple imputation by chained equations was applied. Results: A total of 516 parents of patients with rare diseases completed the online questionnaire. Mean age was 43 years. 87% of respondents accessed the Internet daily, 40% through their smartphones. 99% had an email account, 71% had a Facebook account. 66% participate in an online forum on health. 99% searched for information on disease characteristics, 93% on therapy, 89% on diagnosis, 63% on alternative therapies, 62% on nutrition and 54% on future pregnancies. 82% stated that web information increased comprehension of the disease, 65% that it improved management of the disease. For 52% web information increased his or her anxiety. 62% recognized diagnosis, 69% discussed online information with their physician. People participating in forums more frequently stated that Internet information was useful for recognizing their child's disease (OR 1.68; 95%CI 1.08-2.63) and for improving its management (OR 1.77; 95%CI 1.11-2.81). Conclusion: Italian parents of patients with rare diseases are active Internet users, engaged in information search and in online communities. Physicians, health care facilities and health agencies have a great opportunity to engage in online interactions for empowering families of patients of children affected with rare diseases. [ABSTRACT FROM AUTHOR]

Background: Care coordination has increasingly been recognized as an important aspect of high-quality health care delivery. Robust measures of coordination processes will be essential tools to evaluate, guide and support efforts to understand and improve coordination, yet little agreement exists among stakeholders about how to best measure care coordination. We aimed to review and characterize existing measures of care coordination processes and identify areas of high and low density to guide future measure development. Methods: We conducted a systematic review of measures published in MEDLINE through April 2012 and identified from additional key sources and informants. We characterized included measures with respect to the aspects of coordination measured (domain), measurement perspective (patient/family, health care professional, system representative), applicable settings and patient populations (by age and condition), and data used (survey, chart review, administrative claims). Results: Among the 96 included measure instruments, most relied on survey methods (88%) and measured aspects of communication (93%), in particular the transfer of information (81%). Few measured changing coordination needs (11%). Nearly half (49%) of instruments mapped to the patient/family perspective; 29% to the system representative and 27% to the health care professionals perspective. Few instruments were applicable to settings other than primary care (58%), inpatient facilities (25%), and outpatient specialty care (22%). Conclusions: New measures are needed that evaluate changing coordination needs, coordination as perceived by health care professionals, coordination in the home health setting, and for patients at the end of life. [ABSTRACT FROM AUTHOR]

Objectives To explore a community sample of adolescents for engagement with online pain resources. To assess if the use of the Internet to search for health information correlated with measures of coping, risk taking, catastrophizing about pain, and engaging in the self-management of pain. Design A cross-sectional online study of community-based adolescents ( n = 105) recruited via schools to examine their use of the Internet to seek pain-related information. Methods Adolescents completed questionnaires of pain coping, catastrophic thinking, risk-taking behaviour, and medication use. Descriptive analyses were undertaken on event rates of pertinent behaviours, principally on information seeking and pain management behaviour. Correlational analyses were undertaken between coping and information seeking, and medication use. Results Few participants engaged in online pain information seeking. Those who did were more likely to be female and scored higher on medication use, catastrophizing, risk taking, and the total score on the Pain Coping Questionnaire. Conclusions Although adolescents are high users of the Internet, paradoxically they do not appear to use the Internet for information about pain and pain management. Further research should assess inhibitory and disinhibitory factors associated with information seeking about pain and chronic illness on the Internet. Statement of Contribution What is already known on this subject? Internet use in adolescents is common, mobile, and displays a level of technical awareness unparalleled by adults. The internet is postulated in previous research to present a platform for the delivery of health care, particularly information to aid health decision-making for young people. What does this study add? This study explores how adolescents use the internet to look for health information, particularly on pain and where this falls in a general profile of coping with illness. Interestingly and counterintuitively, adolescents did not use the internet to look for health or pain information. We hypothesize that there may be something about information on pain management that does not readily transfer to the digital world in a way that is useful to adolescent users. [ABSTRACT FROM AUTHOR]