Factors influencing health information-seeking behavior in patients with periodontitis: A cross-sectional study

doi:10.21203/rs.3.rs-4924891/v1

Background

To investigate the current status of health information-seeking behavior (HISB) of periodontitis patients, and to identity its main influencing factors using the Comprehensive Model of Information Seeking (CMIS).

Methods

In total, 274 periodontitis patients were recruited from a specialized dental hospital in Hangzhou by purposive sampling method for a cross-sectional study. Data were collected from the patients by using the general information questionnaire, the Health Information Seeking Behavior Scale, the Self-Efficacy Scale for Self-care (SESS), the Short Form of Health Literacy Dental Scale (HeLD⁃14), and the Brief Illness Perception Questionnaire (BIPQ). Univariate analysis and regression analysis were utilized to determine the factors influencing the HISB.

Results

The HISB score of periodontitis patients in this study was 3.68 ± 0.40. The low level of HISB was negatively associated with age of 40 ~ 59 (odds ratio [OR] 0.041, 95% confidence interval [CI] 0.006–0.299), age of 18 ~ 39 (OR 0.053, 95%CI 0.008–0.364), better understandability of information carriers (characteristic) [OR 0.317, 95%CI 0.119–0.840], better satisfaction of information carriers (utility) [OR 0.027, 95%CI 0.008–0.089] and high self-efficacy level [OR 0.124, 95% CI 0.030–0.505].

Conclusions

Elderly patients and those with lower self-efficacy require more attention. In terms of health information, it is important to make the information more understandable and to assess patients' expectations and needs for information in a timely matter, with a goal of improving the recent HISB of Chinese periodontitis patients.

Periodontitis

Health information-seeking behavior

Influencing factors

Illness perception

Self-efficacy

Periodontitis is a common chronic inflammatory disease of the oral cavity¹, which has various degrees of negative physical and psychological effects on patients^2–5. The economic burden of periodontal disease is far-reaching globally, with the indirect costs of severe periodontitis estimated at more than $50 billion⁶, making it one of the major public health problems worldwide⁷.

Health information seeking behavior (HISB) is described as an active or purposeful behavior by an individual to find health information⁸. This behavior promotes patient participation in healthcare decision-making, may facilitate behavioral change, and may also promote psychosocial adaptation to illness^8–11. Dentists face the challenge of promoting compliance with oral hygiene instructions [5], in which HISB may play an important role and consequently, influence the outcomes of the periodontal treatment. There has been a proliferation of studies related to HISB in the diseases, such as osteoporosis¹², shoulder pain¹³, endocrine disease¹⁴ and cancer^15,16, however, little is known about the HISB of patients with periodontitis.

Johnson and Meischke proposed a comprehensive model of information seeking (CMIS)¹⁷ by synthesizing the health belief model¹⁸, the uses and gratifications theory¹⁹, and a model of media exposure and appraisal²⁰. The model suggests that health-related factors provide motivation for information-seeking actions, which are shaped by information carrier factors, as shown in Fig. 1. This study does not intend to examine the model, as it is quite comprehensive. We use the CMIS as a theoretical framework¹⁷, combined with relevant literatures, to conduct operational definitions of variables in the model. Direct experience refers to the experience and knowledge of the personal and social network about the disease, including the individual's disease status, family history, health literacy, and so on. Salience refers to the significance of health information to an individual in relation to the degree of perceived health threat, such as illness anxiety or self-perception. Beliefs are an individual's confidence to solve problems, such as self-efficacy. Information carrier characteristics refer to the characteristics of the content of the information, such as the " degree of understandability of information ". The term utility is derived from economics and is used to measure the degree of consumer satisfaction²¹. Information utility is an evaluation of the benefits, problem solving and value objectives obtained by the user²², and this study focuses on measuring the "degree of satisfaction of information".

There are few studies on HISB in patients with periodontitis. To fill this gap, this study intends to investigate the level of HISB of Chinese periodontitis patients, and to explore the relevant factors that may influence patients' seeking behavior based on the CMIS.

2.1 Study design

2.1.1 Participants

A cross-sectional survey was conducted in the Department of Periodontics of the Stomatology Hospital, Zhejiang University School of Medicine in China from March 2023 to December 2023. All the participants were selected by purposive sampling methods. All questionnaire entries were answered anonymously. Informed consent was signed by all individuals who agreed to participate in this study. Eligibility criteria included: (a) ≥ 18 years old, (b) diagnosis of periodontitis based on the consensus of 2017 World Workshop: interdental clinical attachment loss (CAL) is detectable at ≥ 2 non-adjacent teeth, or buccal or oral CAL ≥ 3 mm with probing pocket depth (PD) > 3 mm is detectable at ≥ 2 teeth ²³ (c) patients having the ability to read and communicate normally. Exclusion criteria included: (a) presence of severe somatic dysfunction and psychiatric disorders, (b) comorbidity with multiple severe systemic diseases. Kendall advocated the estimation of sample size for multivariate analysis, and the number of observations was at least 10 times the number of variables²⁴. A total of 18 variables were involved in this study and 288 questionnaires were finally distributed and 274 were valid, which meets the sample size requirement.

2.1.2 Ethical considerations

The study was approved by the Ethics Committee of the Stomatology Hospital affiliated to Zhejiang University School of Medicine (IP 2023(024)) and was conducted in accordance with the Declaration of Helsinki, as revised in 2013. All patients were informed and consented.

2.1.3 Measurements

General information and oral health status

The general data collection form was designed by the researcher with reference to the literatures and group discussion, which consisted of a total of 15 questions including gender, age, marital status, education level, health insurance, income, internet access, time of diagnosis of periodontitis, stage of periodontitis and etc.

Health information seeking behavior

HISB was measured by the Health Information Seeking Behavior Scale, which was developed by Zamani et al.²⁵ initially and localized into Chinese by Qiuzi Sun et al. in 2019²⁶. The scale consists of 4 dimensions and 43 items. Each item is rated on a 5-point Likert scale (very unimportant = 1, unimportant = 2, average = 3, important = 4, and very important = 5). Items 36 to 43 are reverse scoring questions and the rest are forward scoring questions. The final score is the average of all the items, with higher scores representing higher levels of HISB. Cronbach's α coefficients of HISB was 0.925 in this study. The median score of all patients was used as the cutoff, above which was the “high-level” group and below part was the “low-level” group.

Self-efficacy

The Self-efficacy Scale for Self-care (SESS) was developed by Kakudate et al.²⁷ for assessing the self-efficacy for patients of periodontal disease and modified for Chinese by Wu Di et al. ²⁸. It uses a 5-point Likert-type scale from 1(not confident) to 5(completely confident) and consists of 15 items assessing self-efficacy. This survey verified SESS reliability for internal consistency (Cronbach’s α = 0.912).

Health literacy

The health literacy of patients with periodontitis was measured by the Short Form of Health Literacy Dental Scale (HeLD-14)²⁹, which was widely used in oral diseases. It was adapted by Jones et al. from the full version of the HeLD-29, which consists of 7 dimensions and 14 items. Entries were rated on a 5-point Likert scale, with 1 meaning "not difficult at all" and 5 meaning "cannot do it at all". When analyzing the scores, they were converted to calculate the total score, for example, 5 to 0, 4 to 1, etc. The higher the score, the higher the level of oral health literacy. Wen Yan et al. localized to Chinese in 2021³⁰. This survey verified HeLD-14 reliability for internal consistency (Cronbach’s α = 0.959).

Illness perception

The Brief Illness Perception Questionnaire (BIPQ) was developed by Broadbent et al. in 2006³¹. It has been used to assess patient perceptions in a variety of chronic conditions. Yaqi Mei et al. modify it for Chinese in 2015³². The scale consists of 9 items with 3 dimensions: cognition (items 1, 2, 3, 4, 5), emotion (items 6, 8), and comprehension (item 7), and the 9th item is a causality question about the cause of the disease (“Please list in order the 3 most important factors that you believe have contributed to your disease. The most important cause for me is __”). Each entry is scored on a 0–10 points range (with reverse scoring for entries 3, 4, and 7), with higher scores representing more negative perceptions and more severe symptoms of the disease. Cronbach's α coefficients for this scale was 0.691 in this study.

2.2 Data collection

Data were collected by Xu Y.X., Wang M.L. and Bao L., who had received the same training to minimize bias in the interpretation of scale entries during data collection. Each participant completed the questionnaire filling under the guidance of one of them.

2.3 Data Analysis

SPSS (Win version 26.0) was used to analyze the data. The normality of the study variables was tested with the Kolmogorov–Smirnov test. Comparisons between groups were made using the χ2 test. For variables that did not meet the application conditions of the χ2 test, Fisher's exact probability method was used. Regression analysis was performed using a binary logistic regression model, with level of HISB as the dependent variable to analyze the factors influencing the "low level" of HISB and were expressed as ratios (ORs) and their 95% confidence intervals (95% CIs). Statistical significance was set at p < 0.05.

3.1 Sociodemographic characteristics

The questionnaire completion rate for this investigation was 95.1% (274/288). Table 2 presents the general characteristics of the study population. The mean age of the respondents was 41.4 ± 13.3 years old and the sex ratio was balanced (149 male/125 female). Most of respondents were in their middle age (50.7%), married (74.1%), living in towns (79.9%) and having a bachelor's degree or higher (63.5%). Only 5.1% of respondents do not have health insurance, and 79.1% of respondents have income of family more than 5,000 yuan monthly.

3.2 Oral health status

As shown in Table 2, the largest part patients (42.7%) have been diagnosed with periodontitis for more than 3 years in this study. Stage I of periodontitis accounted for 42.7%, Stage II accounted for 34.3%, while Stage III and IV accounted for 43.8%. Most of the patients (62.4%) had other concomitant oral diseases. Patients without family history of periodontitis were in majority (59.5%).

3.3 Health information-related content

As shown in Table 2, 50.4% of the participants had experience of seeking information for their families or friends. 89.1% of the participants had access to the internet and the majority of the participants found the health information provided by their healthcare provider comprehensible (89.8%) and satisfied (94.5%).

3.4 Health information seeking behavior score

The average score of the HISB scale was 3.68 ± 0.40 in this study. The HISB scale was divided into: “Attitude to health information”, “Information needs”, “Sources of information”, “Barriers to access health information” four dimensions The mean score for each dimension was 4.24 ± 0.69, 4.40 ± 0.52, 3.44 ± 0.57, and 2.43 ± 0.96, respectively. (Table 1)

3.5 The influencing factors associated with the health information seeking behavior

To determine the factors that may influence patients' HISB, we conducted univariate analysis of the included variables. There were 12 independent variables have been identified significantly associated with levels of HISB, including age, residence, education level, family income per month (yuan), insurance type, number of other oral diseases, have experience of seeking information for families or friends, internet access, degree of understandability of the information, degree of satisfaction of the information, level of self-efficacy and level of health literacy (p < 0.05).

Above 12 variables were further analyzed by using a binary logistic regression analysis to provide the adjustment of potential influences from other confounding factors. The results showed that age of 40~59，age of 18~39, characteristic of information carriers (degree of understandability), utility of information carriers (degree of satisfaction) and self-efficacy were negatively associated with the level of patients' HISB (p < 0.05). Detailed data are presented in Table 3.

Poor adherence in patients with periodontitis has been a major concern in the area of dentistry. It is clear from the above that HISB is a prerequisite for behavioral change in health promotion⁸. To the best of our knowledge, this is the first study of HISB in periodontitis patients, with the aim of investigating the level of behavior and the associated influencing factors. The results showed that the HISB level of periodontitis patients in present study is acceptable but still needs to be improved. We found that HISB of periodontitis patients was associated with age, information carrier factors, and self-efficacy.

The HISB score of the patients in this research was 3.68 ± 0.40. It is higher than the level of patients with systemic chronic diseases^26,33, which may be due to the lower proportion of elderly people in the present study, and the younger patients were more concerned about their oral health. According to the mean scores of four dimensions above, we can see that patients have a positive attitude and strong demand for health information related to periodontitis, which are good signs. The average scores were 4.24 and 4.40 (maximum score = 5), respectively.

Doctors, nurses and healthcare organizations ranked as top 3 sources of HISB in present study (Table 1), which was in consistent with the results of previous study conducted by Diviani et al.³⁴. But the point is not just about trust, but also about behavioral change. Patients' desire for information and participation in healthcare decision-making may require longer interaction times to be reflected in information-seeking communication behaviors³⁵. With the current high outpatient attendance in the department of periodontics in China ³⁶, the high percentage of time set aside for treatment, and the concomitant understaffing of nursing staff and assistants, additional interaction time is a challenge. HISB consists of two forms, online and offline. The Internet has become the primary medium for online HISB⁸. It is gradually replacing media such as paper-based information, television and radio. The Internet penetration rate in China reached 76.4%³⁷. However, in this survey, the score of using Internet was ranked sixth, which may be due to the low quality of online health information that makes people confused and worried³⁸. Also, ineffective hyperlinks and poor navigation make online health information inaccessible to the patients³⁹. In order to solve the above difficulties, tele-dentistry can be developed for internet health information provision and patient management. As in the case of the promotion of Internet hospitals and the upgrading of their functions, it is important to take into account the convenience of operation and the specialization of information resources.

Compared to the patients with systemic chronic diseases in previous study, barriers to seeking information in our study are less^25,33. It may be related to the fact that more of the study subjects in this study suffered from periodontitis for more than 1 year. Regular follow-up visits give patients a better understanding of medical terminology related to periodontitis, and patients would trust the information provided by the hospital, which they would perceive as authoritative and reliable, and will not be uncertain about the information.

By using a binary logistic regression analysis, our study indicated that higher levels of HISB were positively associated with younger age, higher self-efficacy, better degree of understandability and satisfaction of the information. The role of age in the HISB is controversial. Diviani et al. did not find a correlation between age and HISB³⁴ and but Powell et al. found increased information-seeking behaviors of women in 56–65,compare other age bands⁴⁰. But in this study, the younger were more likely to search for information. This may due to the decline in cognitive function, hearing, and responsiveness among the elderly. As to the aspect of information carriers, we conclude from the results that the characteristics and utility of information carriers are significant predictors of HISB for patients with periodontitis. Characteristics and utility of information carriers do affect patients' behavior^33,41. This suggests that there is a need to provide health information that is understandable and needed. In present study, self-efficacy significantly and positively influences patients' HISB. It can be explained by that the SESS scale has high sensitivity for measuring the self-management level of patients with periodontitis, based on the Bandura's self-efficacy theory⁴². Cui et al. reported similar results that patients with low self-efficacy should receive more attention³³.

In this study, there was no correlation between health literacy and HISB. In contrast to our results, previous surveys found that people with higher health literacy were more active information seekers^33,43. It is might be explained by the insidious onset of periodontitis. Patients who were able to actively seek medical care were already among those who were more concerned about their oral health. Besides, People living in areas with lower socioeconomic conditions were more likely to have limited health literacy⁴⁴. However, this study was conducted in one of the developed cities in China.

Based on the CMIS model, illness perception did not show a correlation with HISB in our study, suggesting that patients with periodontitis are still not sufficiently sensitized to the threat of the disease. According to the data of other outpatients in China⁴⁵, the self-perception (BIPQ score was 38.24 ± 8.82) was in a low or medium level in our study. This may be related to the fact that the pain associated with the physical discomfort caused by periodontitis itself is mild and not life-threatening.

There are several limitations of this study that must be recognized. The population of this study was from a single center and the behavior was examined at a single time point and longitudinal observations were lacking. In future, it is necessary to design multicenter and longitudinal studies to observe HISB of patients with periodontitis over an extended period of time. It has been noted in the literature that HISB predisposes patients to self-diagnosis, leading to nonadherence to treatment⁹. The present study did not track patients' late follow-up visits due to the time of observation, but loss of visits could be considered as an observational outcome in later studies.

The level of HISB among Chinese periodontitis patients remains to be improved, and it is crucial to encourage patients to be proactive in learning health information. HISB were significantly associated with age, self-efficacy, degree of understandability and satisfaction of the information carriers. More attention should be paid to aged patients and those with low self-efficacy levels. It is essential to provide them with health information that is easily understandable and tailored to their specific requirements.

CMIS: Comprehensive Model of Information Seeking

HISB: Health Information Seeking Behavior

SESS: Self-efficacy scale for self-care

HeLD⁃14: Short Form of Health Literacy Dental Scale

BIPQ: Brief Illness Perception Questionnaire

PD: Pocket depth

Acknowledgments

Not applicable.

Authors’ contributions

YXX, MLW, XJL and ZJC designed the study. YXX, MLW and LB collected the data. YXX and ZJC analyzed the data. YXX and LB drafted and wrote the manuscript. XJL, ZJC and MLW revised the manuscript. All authors read and approved the final manuscript.

Funding

This study was supported by National Key Research and Development Program of China (No.2023YFC2506300), Young Elite Scientist Support Program of CSA (2020PYRC001) and Exploration and Development Project of ZJUSS (RD2022DXKB03).

Declaration

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, IP 2023 (024), and carried out in accordance with the Declaration of Helsinki, as revised in 2013. This was a cross-sectional study in the form of a questionnaire and all participants gave informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Chapple ILC. Time to take periodontitis seriously. BMJ. 2014;348(apr10 1):g2645-g2645. doi:10.1136/bmj.g2645
Zheng D, Kang X, Wang Y, et al. Periodontal disease and emotional disorders: A meta‐analysis. J Clin Periodontol. 2021;48(2):180-204. doi:10.1111/jcpe.13395
Meng H, Shu R, Yan F. Peridontology. 5th ed. People’s Medical Publishing House; 2020.
Ball J, Darby I. Mental health and periodontal and peri‐implant diseases. Periodontol 2000. 2022;90(1):106-124. doi:10.1111/prd.12452
Janakiram C, Dye BA. A public health approach for prevention of periodontal disease. Periodontol 2000. 2020;84(1):202-214. doi:10.1111/prd.12337
Listl S, Galloway J, Mossey PA, Marcenes W. Global Economic Impact of Dental Diseases. J Dent Res. 2015;94(10):1355-1361. doi:10.1177/0022034515602879
Peres MA, Macpherson LMD, Weyant RJ, et al. Oral diseases: a global public health challenge. The Lancet. 2019;394(10194):249-260. doi:10.1016/S0140-6736(19)31146-8
Zimmerman MS, Shaw G. Health information seeking behaviour: a concept analysis. Health Inf Libr J. 2020;37(3):173-191. doi:10.1111/hir.12287
Anker AE, Reinhart AM, Feeley TH. Health information seeking: A review of measures and methods. Patient Educ Couns. 2011;82(3):346-354. doi:10.1016/j.pec.2010.12.008
Lambert SD, Loiselle CG. Health Information—Seeking Behavior. Qual Health Res. 2007;17(8):1006-1019. doi:10.1177/1049732307305199
Welton-Mitchell C, Dally M, Dickinson KL, Morris-Neuberger L, Roberts JD, Blanch-Hartigan D. Influence of mental health on information seeking, risk perception and mask wearing self-efficacy during the early months of the COVID-19 pandemic: a longitudinal panel study across 6 U.S. States. BMC Psychol. 2023;11(1):203. doi:10.1186/s40359-023-01241-z
Ansari A, Fahimfar N, Noruzi A, et al. Health information-seeking behavior and self-care in women with osteoporosis: a qualitative study. Arch Osteoporos. 2021;16(1):78. doi:10.1007/s11657-021-00923-8
Miller AS, Stetler P, Sharma S, et al. Determining health information-seeking behavior of shoulder patients. J Shoulder Elbow Surg. 2022;31(6S):S57-S62. doi:10.1016/j.jse.2021.12.038
Kyriacou A, Sherratt C. Online health information-seeking behavior by endocrinology patients. Horm Athens Greece. 2019;18(4):495-505. doi:10.1007/s42000-019-00159-9
Rexhepi H, Huvila I, Åhlfeldt RM, Cajander Å. Cancer patients’ information seeking behavior related to online electronic healthcare records. Health Informatics J. 2021;27(3):14604582211024708. doi:10.1177/14604582211024708
Liu Z, Whitener G, Hwang CL. Association of online health information seeking behavior with levels of knowledge about palliative care among older adults. Geriatr Nurs N Y N. 2023;49:8-12. doi:10.1016/j.gerinurse.2022.11.004
Johnson JD, Meischke H. A Comprehensive Model of Cancer-Related Information Seeking Applied to Magazines. Hum Commun Res. 1993;19(3):343-367. doi:10.1111/j.1468-2958.1993.tb00305.x
Rosenstock IM. Historical Origins of the Health Belief Model. Health Educ Monogr. 1974;2(4):328-335. doi:10.1177/109019817400200403
Rubin AM. Uses, gratifications, and media effects research. Perspect Media Eff. Published online 1986:281-301.
Johnson JD. A test of a model of magazine exposure and appraisal in India. Commun Monogr. 1983;50(2):148-157. doi:10.1080/03637758309390159
Marschak J. Rational Behavior, Uncertain Prospects, and Measurable Utility. Econometrica. 1950;18(2):111-141. doi:10.2307/1907264
Chen J. The theory of information utility and its implementation process. J Peking Univ Philos Soc Sci Ed. 1996;(3):36-40.
Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Clin Periodontol. 2018;45:S149-S161. doi:10.1111/jcpe.12945
Li Z, Liu Y. Nursing Research Methods. 2th ed. People’s Medical Publishing House; 2018.
Zamani M, Soleymani MR, Afshar M, Shahrzadi L, Zadeh AH. Information-seeking behavior of cardiovascular disease patients in Isfahan University of Medical Sciences hospitals. J Educ Health Promot. 2014;3:83. doi:10.4103/2277-9531.139249
Sun Q, Zhou W, Zhang Y, Zhang F. Investigation and analysis of health information—seeking behavior among patients with chronic disease. J Nurs Sci. 2019;34(9):84-86.
Kakudate On, Morita M, Fujisawa M, Nagayama M, Kawanami M. Development of the Self-Efficacy Scale for Self-care (SESS)among Periodontal Disease Patients. J Jpn Soc Periodontol. 2007;49(4):285-295.
Wu D, Zhang Y, Liang H, Wang CM. Reliability and Validity of Chinese version of self-efficacy scale for self-care. Chin J Nurs. 2015;50(6):758-762.
Jones K, Brennan D, Parker E, Jamieson L. Development of a short‐form Health Literacy Dental Scale (He LD ‐14). Community Dent Oral Epidemiol. 2015;43(2):143-151. doi:10.1111/cdoe.12133
Yan W, Ju X, Jamieson L, Liu F. Sinicization and reliability and validity test of the short-form of Health Literacy in Dentistry(HeLD-14). Chin Nurs Res. 2021;35(20):3612-3616.
Broadbent E, Petrie KJ, Main J, Weinman J. The Brief Illness Perception Questionnaire. J Psychosom Res. 2006;60(6):631-637. doi:10.1016/j.jpsychores.2005.10.020
Mei Y, Li H, Yang Y, et al. Reliability and Validity of Chinese Version of the Brief Illness Perception Questionnaire in Patients with Breast Cancer. J Nursing（China）. 2015;22(24):11-14.
Cui P, Ni X, Zong M, Xin X, Jiang Y, Li X. Status and path analysis of influencing factors of the health information seeking behavior in elderly patients with chronic diseases. J Shanghai Jiao Tong Univ Sci. 2022;42(6):805-812.
Diviani N, Zanini C, Jaks R, Brach M, Gemperli A, Rubinelli S. Information seeking behavior and perceived health literacy of family caregivers of persons living with a chronic condition. The case of spinal cord injury in Switzerland. Patient Educ Couns. 2020;103(8):1531-1537. doi:10.1016/j.pec.2020.02.024
Beisecker AE, Beisecker TD. Patient Information-Seeking Behaviors When Communicating With Doctors: Med Care. 1990;28(1):19-28. doi:10.1097/00005650-199001000-00004
Liu T, Shi D, Xiao W, Liu K, Liu J. Investigation and response to periodontal patients′failure of subsequent visit in outpatient service. Chin J Mod Nurs. 2016;22(9):1235-1238. doi:10.3760/cma.j.issn.1674-2907.2016.09.013
Chinese Statistical Report on Internet Development (52nd version). China Internet Network Information Centre (CNNIC); 2023.
Reiff M, Bernhardt BA, Mulchandani S, et al. “What does it mean?”: Uncertainties in understanding results of chromosomal microarray testing. Genet Med. 2012;14(2):250-258. doi:10.1038/gim.2011.52
Cao W, Zhang X, Xu K, Wang Y. Modeling Online Health Information-Seeking Behavior in China: The Roles of Source Characteristics, Reward Assessment, and Internet Self-Efficacy. Health Commun. 2016;31(9):1105-1114. doi:10.1080/10410236.2015.1045236
Powell J, Inglis N, Ronnie J, Large S. The Characteristics and Motivations of Online Health Information Seekers: Cross-Sectional Survey and Qualitative Interview Study. J Med Internet Res. 2011;13(1):e20. doi:10.2196/jmir.1600
Xiao Z, Lee J, Zeng L, Ni L. Information seeking in the context of cigarette smoking: predictors from the Comprehensive Model of Information Seeking (CMIS). Psychol Health Med. 2020;25(10):1228-1246. doi:10.1080/13548506.2020.1728348
Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215. doi:10.1037/0033-295X.84.2.191
Kim SH, Utz S. Association of health literacy with health information‐seeking preference in older people: A correlational, descriptive study. Nurs Health Sci. 2018;20(3):355-360. doi:10.1111/nhs.12413
Sundell E, Wångdahl J, Grauman Å. Health literacy and digital health information-seeking behavior - a cross-sectional study among highly educated Swedes. BMC Public Health. 2022;22(1):2278. doi:10.1186/s12889-022-14751-z
Wu H, Zhao X, Fritzsche K, et al. Negative illness perceptions associated with low mental and physical health status in general hospital outpatients in China. Psychol Health Med. 2014;19(3):273-285. doi:10.1080/13548506.2013.802358

Table 1 Health Information Seeking Behavior Score for Patients with Periodontitis (N=274)

Dimensions	Items	Mean ± standard deviation (SD)
Attitude to health information		4.24 ± 0.69
	Positive effects of health information on increasing hopefulness	4.31 ± 0.77
	Positive effects of health information to find the best way for treatment	4.36 ± 0.75
	Positive effects of health information to control the disease	4.33 ± 0.75
	Positive effects of health information to control the complications of medicines	4.18 ± 0.82
	Knowing useful health information about disease	4.28 ± 0.79
	Increase of anxiety caused by the lack of health information	3.94 ± 0.96
Information needs		4.40 ± 0.52
	Finding reliable physicians	4.67 ± 0.54
	Finding appropriate treatment methods	4.64 ± 0.56
	Awareness of disease prevention	4.51 ± 0.65
	Awareness of symptoms	4.39 ± 0.75
	Finding the right medical centers	4.58 ± 0.61
	Chance of recovery	4.45 ± 0.66
	Drug information	4.24 ± 0.76
	Find information on disease control methods	4.37 ± 0.67
	Increased awareness of risk factors of disease	4.35 ± 0.66
	Awareness of the factors of developing disease	4.28 ± 0.77
	Information about the stage of disease	4.35 ± 0.68
	Awareness of the nature of the disease	4.30 ± 0.71
	Information about treatment costs	4.13 ± 0.81
	Awareness of the adverse effects of treatment	4.32 ± 0.73
Sources of information		3.44 ± 0.57
	Physician/Doctor	4.71 ± 0.48
	Nurse	4.31 ± 0.81
	TV	3.07 ± 1.06
	Other patients	3.48 ± 0.97
	Family	3.88 ± 0.86
	Internet	3.59 ± 0.96
	Friend and colleague	3.63 ± 0.84
	Healthcare organizations	4.20 ± 0.76
	Medical books	3.69 ± 0.99
	Newspaper	3.03 ± 1.07
	Magazine	2.92 ± 1.08
	Radio	2.65 ± 1.05
	Leaflet	2.73 ± 1.05
	Telephone counseling services	3.11 ± 1.08
	Librarian	2.52 ± 1.01
Barriers to access health information		2.43 ± 0.96
	Lack of familiarity with medical terminology	2.43 ± 1.14
	Lack of access to authoritative information resources	2.40 ± 1.17
	Uncertainty about received information	2.39 ± 1.17
	Lack of knowledge about reliable information sources	2.35 ± 1.16
	Lack of skills to use information resources	2.39 ± 1.11
	Lack of staff's accountability	2.31 ± 1.29
	Information overload	2.50 ± 1.06
	Not healthy enough to seek information	2.67 ± 1.12

Table 2 Comparison of health information seeking behavior among periodontitis patients with different characteristic (N=274)

Variables	Variable Categories	Total, n (%)	Mean ± standard deviation (SD)	c²	p
Gender	Male	149 (54.4)	3.68 ± 0.03	0.009	0.924
	Female	125 (45.6)	3.67 ± 0.03
Age	18~39	139 (50.7)	3.73 ± 0.03	28.428	＜0.001*
	40~59	96 (35.0)	3.75 ± 0.04
	≥60	39 (14.2)	3.30 ± 0.05
Marital status	Married	203 (74.1)	3.67 ± 0.03	0.359	0.549
	Single or other	71 (25.9)	3.68 ± 0.04
Residence	Town	219 (79.9)	3.68 ± 0.03	4.094	0.043*
	Country	55 (20.1)	3.65 ± 0.06
Education level	Below Bachelor's Degree	100 (36.5)	3.63 ± 0.04	4.805	0.028*
	Bachelor's Degree and above	174 (63.5)	3.70 ± 0.03
Income of family per month(yuan)	﹤5000RMB	57 (20.8)	3.43 ± 0.05	20.564	＜0.001*
	5000~10000RMB	102 (37.2)	3.74 ± 0.04
	﹥10,000RMB	115 (42.0)	3.74 ± 0.03
Insurance Type	New Rural Cooperative Medical Insurance	12 (4.4)	3.55 ± 0.05	20.893	＜0.001*
	Employee insurance	191 (69.7)	3.75 ± 0.03
	Residential insurance	52 (19.0)	3.45 ± 0.05
	Commercial insurance	5 (1.8)	3.64 ± 0.21
	Not insured	14 (5.1)	3.58 ± 0.10
Duration of periodontitis	≤1 year	98 (35.8)	3.65 ± 0.03	1.225	0.542
	1~3years	59 (21.5)	3.73 ± 0.06
	≥3 years	117 (42.7)	3.67 ± 0.04
Stage of periodontitis	Mild（stage I）	60 (21.9)	3.65 ± 0.04	0.791	0.673
	Moderate（stage II）	94 (34.3)	3.67 ± 0.04
	Severe（stage III and IV）	120 (43.8)	3.69 ± 0.04
Number of other oral diseases	0	103 (37.6)	3.76 ± 0.04	11.903	0.003*
	﹤3	134 (48.9)	3.65 ± 0.04
	≥3	37 (13.5)	3.51 ± 0.06
A family history of periodontitis	Yes	111 (40.5)	3.66 ± 0.04	1.433	0.231
	No	163 (59.5)	3.69 ± 0.03
Experience of seeking information for families or friends	Yes	138 (50.4)	3.74 ± 0.03	5.330	0.021*
	No	136 (49.6)	3.60 ± 0.04
Internet access	Yes	244 (89.1)	3.72 ± 0.02	15.016	＜0.001*
	No	30 (10.9)	3.32 ± 0.06
Better understandability of information	Yes	197 (71.9)	3.73 ± 0.02	12.209	＜0.001*
	No	77 (28.1)	3.18 ± 0.04
Better satisfaction of information	Yes	192 (70.1)	3.70 ± 0.02	53.620	＜0.001*
	No	82 (29.9)	3.18 ± 0.06
Level of Self-efficacy^†	High (60~75 points)	157 (57.3)	3.79 ± 0.03	34.470	＜0.001*
	Medium (54~59 points)	73 (26.6)	3.59 ± 0.04
	Low (15~53 points)	44 (16.1)	3.38 ± 0.05
Level of Health literacy^†	High (47~70 points)	258 (94.2)	3.71 ± 0.02	10.255	0.005*^‡
	Medium (36~46 points)	4 (1.5)	3.08 ± 0.08
	Low (14~35 points)	12 (4.4)	3.13 ± 0.09
Level of Illness perception^†	High (48~80 points)	36 (13.1)	3.68 ± 0.06	0.311	0.856
	Medium (30~47 points)	199 (72.6)	3.68 ± 0.03
	Low (0~29 points)	39 (14.2)	3.63 ± 0.05

^†Level of Self-efficacy and level of health literacy were classified according to the authors of the source scale's pre-existing grading cut-off, and the level of ill perception was graded according to the data of the current study by adopting the standard deviation method.

* p value < 0.05.

^‡Fisher exact test

Table 3 Multivariate Logistic regression analysis of different level of health information seeking behavior (N=274)

Variables		β		SE	Wald χ²	P	OR（95%CI）
Age	≥60	Reference
	40~59	-3.196	1.014		9.926	0.002**	0.041 (0.006, 0.299)
	18~39	-2.931	0.980		8.942	0.003**	0.053 (0.008, 0.364)
Residence	Town	Reference
	Country	0.347	0.475		0.534	0.465	1.415 (0.558, 3.593)
Education level	Below Bachelor's Degree	Reference
	Bachelor's Degree and above	-0.096	0.443		0.047	0.828	0.908 (0.381, 2.165)
Income of family per month (yuan)	﹤5000 RMB	Reference
	5000~10000 RMB	-0.554	0.546		1.032	0.310	0.574 (0.197, 1.674)
	﹥10,000 RMB	-1.004	0.563		3.176	0.075	0.366 (0.122, 1.105)
Insurance Type	New Rural Cooperative Medical Insurance	Reference
	Employee insurance	-1.254	1.000		1.572	0.210	0.258 (0.040, 2.026)
	Residential insurance	-0.840	1.094		0.590	0.442	0.432 (0.051, 3.684)
	Commercial insurance	-1.778	1.824		0.950	0.330	0.169 (0.005, 6.032)
	Not insured	-1.684	1.252		1.810	0.178	0.186 (0.016, 2.158)
Number of other oral diseases	0	Reference
	﹤3	0.262	0.359		0.530	0.467	1.299 (0.642, 2.628)
	≥ 3	0.479	0.629		0.578	0.447	1.614 (0.470, 5.541)
Experience of seeking information for families or friends	Yes	Reference
	No	0.442	0.342		1.669	0.196	1.556 (0.796, 3.045)
Internet access	Yes	Reference
	No	1.199	0.792		2.293	0.130	3.317 (0.703, 15.656)
Better understandability of informatio	Yes	Reference
	No	-1.150	0.498		5.335	0.021**	0.317 (0.119, 0.840)
Better satisfaction of information	Yes	Reference
	No	-3.598	0.600		35.944	﹤0.001**	0.027 (0.008, 0.089)
Level of Self-efficacy	Low	Reference
	Medium	-0.952	0.723		1.733	0.188	0.386 (0.094, 1.592)
	High	-2.087	0.716		8.493	0.004**	0.124 (0.030, 0.505)
Level of Health literacy	Low	Reference
	Medium	-0.649	1.874		0.120	0.729	0.522 (0.013, 20.584)
	High	-0.593	1.325		0.165	0.684	0.583 (0.043, 7.828)

** p value < 0.05.

No competing interests reported.

Factors influencing health information-seeking behavior in patients with periodontitis: A cross-sectional study

Status:

Journal Publication

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

1 Introduction

2 Methods

2.1 Study design

2.1.1 Participants

2.1.2 Ethical considerations

2.1.3 Measurements

2.2 Data collection

2.3 Data Analysis

3 Results

4 Discussion

5 Conclusion

Abbreviations

Declarations

References

Tables

Additional Declarations

Status:

Journal Publication

Version 1