Online health communities (OHCs) have become new venues for online professional-patient interactions in which patients, as OHC users, can undertake online consultations with health professional ...moderators. This interaction has previously been investigated mainly from the user's perspective, whilst neglecting the insights of health professional moderators. The aim of this study is to explore and compare the benefits and challenges of online professional-patient interactions for users and health professional moderators and the effects on face-to-face medical encounters. The study employed a qualitative research design, with in-depth, semi-structured interviews conducted with users (n = 8) and health professional moderators (n = 7) from the largest OHC in Slovenia. Data analysis utilised inductive thematic analysis and principles of grounded theory. The results of this small study demonstrate that the OHC enabled users and health professional moderators to overcome weaknesses of face-to-face medical encounters. Both users and professionals view the primary benefits of online professional-patient interaction as delivering informational and emotional support for users' health-related needs. The main challenges for users and health professional moderators stem from the limitations of computer-mediated communication (CMC). Users and health professional moderators expressed different and ambivalent attitudes toward the OHC and its effect on face-to-face medical encounters.
•Online professional-patient interaction benefits pertain to online social support.•OHC users see the main benefits in receiving informational online social support.•Health professional moderators view benefits in addressing users' health needs.•Online professional-patient interaction challenges stem from limitations of CMC.•Interactions in OHCs can overcome weaknesses of face-to-face medical encounters.
The role of online health communities (OHCs) in patient empowerment is growing and has been increasingly studied in recent years. Research has focused primarily on individualistic conception of ...patients' empowerment, with much less attention paid to the role of OHCs in the development of patients' collective empowerment. Although OHCs have immense potential for empowerment that goes beyond the individual, the concept and scale of collective empowerment in OHCs have not yet been developed or validated.
This study aimed to develop an instrument for measuring collective empowerment in online health communities (CE-OHC) and to test its quality by investigating its factorial structure, reliability, construct validity, and predictive validity.
The CE-OHC scale was developed according to a strict methodology for developing valid and reliable scales. An initial set of 20 items was first tested in the pilot study conducted in 2016 using a sample of 280 registered users of Slovenia's largest OHC. A refined version with 11 items was tested in the main study conducted in 2018 on a random sample of 30,000 registered users of the same OHC. The final sample comprised 784 users. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate the factorial structure, discriminant validity, and convergent validity of the scale. Cronbach alpha coefficient was used to determine the CE-OHC scale's internal consistency. To establish the predictive validity, ordinary least squares regression was performed to test the role of CE-OHC in users' civic participation.
The EFA resulted in a two-factor solution, and the two factors-knowledge of resources and resource mobilization for collective action-together explain 63.8% of the variance. The second-order CFA demonstrated a good fit to the data (root mean square error of approximation=0.07) and the scale had a good internal consistency (alpha=.86). Although evidence of the scale's convergent validity was partially provided, discriminant validity of the scale remained unconfirmed. Overall, CE-OHC was confirmed to be a predictor of users' civic participation, but the influence was somewhat weak and inconsistent across two subscales.
The proposed CE-OHC scale is a reliable and relatively valid instrument and serves as a good baseline to advance the measurement of collective empowerment in OHC contexts. This is the first scale developed for this purpose, and future research should focus on the development of a clear nomological network of the collective empowerment construct in relation to the OHC settings.
•Objective organizational norms have stronger effect on susceptibility to phishing than perceptions of norms.•Personal norms reduce clicking, but not providing data on phishing emails.•Injunctive ...norms reduce susceptibility to phishing.•Formal norms reduce susceptibility to phishing.•Descriptive norms elicit boomerang effect on susceptibility to phishing.
Phishing is one of the most common forms of social engineering that exploits human vulnerabilities and causes immense personal and organizational costs. This study advances the research on the factors of susceptibility to phishing in three regards. First, it addressed the role of organizational norms in susceptibility to phishing. Second, it aimed for high external and ecological validity by combining survey and phishing experiments data on large samples of organizations and their employees. Third, it employed a two-level design that considered explanatory variables at the individual and organizational levels. The study chiefly explored how formal, descriptive, injunctive, and personal norms influence employee interactions with phishing emails. To this end, an explanatory model was tested on 83,269 employees in 510 organizations using a multilevel modeling approach. Clicking on links in simulated phishing emails and entering personal information in simulated fraudulent websites were deemed as two types of susceptibility to phishing. Formal norms and collectively shared injunctive norms were found to exert the strongest effects on susceptibility to phishing; in contrast, personal norms exert a weak influence, and descriptive norms can result in a boomerang effect. These results have significant theoretical and practical implications for both researchers and managers seeking organizational-level mechanisms to reduce the threat of phishing emails.
Conversations among online community members as a form of everyday, unconstrained, flexible, and spontaneous communication are important for developing a sense of community, sustainability of online ...communities, construction of identity, public sphere, and for creating and maintaining offline taken-for-granted basic structures of everyday life. While the lack of qualities of online conversations in online communities is often discussed and researched, we argue that its positive sides should also be conceptualized and become the subject of quantitative empirical research. The purpose of this paper is to introduce the concept and scale of perceived quality of online conversations and inspect the psychometric properties of the proposed scale in terms of content and convergent, discriminant, and criterion validity and reliability. The paper presents a five-factor structure of the quality of conversation scale, which is tested for its quality on a sample of 1,276 online community participants. Confirmatory factor analysis supports the proposed multidimensional structure, while correlational and regression analyses demonstrate good levels of convergent, discriminant and criterion validity. The paper suggests several refinements of the measurement instrument, and concludes with the usefulness of the introduced scale for the research and understanding of the online community phenomenon.
Highlights • Participation in OHCs brings benefits also to health professionals, not only users. • Health professional moderators see themselves as agents of users’ empowerment process/outcomes. • ...Being a health professional moderator can be personally and professionally (dis)empowering. • Participation in OHCs can improve the quality of professional-patient interaction.
Substantial research demonstrates the importance of online health communities (OHCs) for patient empowerment, although the impact on the patient-physician relationship is understudied. Patient ...empowerment also occurs in relationship with the physician, but studies of OHCs mostly disregard this. The question also remains about the nature and consequences of this empowerment, as it might be based on the limited validity of some information in OHCs.
The main purpose of this study was to examine the impact of social processes in OHCs (information exchange with users and health professional moderators, social support, finding meaning, and self-expressing) on functional and dysfunctional patient empowerment in relationship with the physician (PERP). This impact was investigated by taking into account moderating role of eHealth literacy and physician's paternalism.
An email list-based Web survey on a simple random sample of 25,000 registered users of the most popular general OHC in Slovenia was conducted. A total of 1572 respondents completed the survey. The analyses were conducted on a subsample of 591 regular users, who had visited a physician at least once in the past 2 years. To estimate the impact of social processes in OHC on functional and dysfunctional PERP, we performed a series of hierarchical regression analyses. To determine the moderating role of eHealth literacy and the perceived physician characteristics, interactions were included in the regression analyses.
The mean age of the respondents in the sample was 37.6 years (SD 10.3) and 83.3% were females. Factor analyses of the PERP revealed a five-factor structure with acceptable fit (root-mean-square error of approximation =.06). Most important results are that functional self-efficacy is positively predicted by information exchange with health professional moderators (beta=.12, P=.02), information exchange with users (beta=.12, P=.05), and giving social support (beta=.13, P=.02), but negatively predicted with receiving social support (beta=-.21, P<.001). Functional control is also predicted by information exchange with health professional moderators (beta=.16, P=.005). Dysfunctional control and competence are inhibited by information exchanges with health professionals (beta=-.12, P=.03), whereas dysfunctional self-efficacy is inhibited by self-expressing (beta=-.12, P=.05). The process of finding meaning likely leads to the development of dysfunctional competences and control if the physician is perceived to be paternalistic (beta=.14, P=.03). Under the condition of high eHealth literacy, the process of finding meaning will inhibit the development of dysfunctional competences and control (beta=-.17, P=.01).
Social processes in OHCs do not have a uniform impact on PERP. This impact is moderated by eHealth literacy and physician paternalism. Exchanging information with health professional moderators in OHCs is the most important factor for stimulating functional PERP as well as diminishing dysfunctional PERP. Social support in OHCs plays an ambiguous role, often making patients behave in a strategic, uncooperative way toward physicians.
In the research of online communities and web survey methodology little is known about how elements in email invitations to list-based web surveys can be used to obtain higher response rates. In the ...present work, we investigated whether making authority, plea for help, and sense of community salient in email invitations determines the response of survey participants. Drawing from both survey methodology and recent research on online communities, this study also tested a hypothesis on the relationship between activity in an online community and survey response. Using a full-factorial experiment based on a simple random sample of 2500 members from the largest online health community in Slovenia, the results support only the hypothesis that plea for help is an effective response-inducing element in email invitations. Furthermore, the results support the hypotheses that online community activity, related to the frequency of visits and number of posts to an online community, are positively associated with response in list-based web survey. Since this study also shows that combining more than one element in email invitations does not necessary improve response rates, web survey research and practice may benefit from future research on this topic.
•We experiment with content of email invitations to web survey in online community.•Authority, plea for help, and sense of community are tested as soliciting elements.•Plea for help in an email invitation increases the response rate.•Using more than one element does not necessary improve the response rate.•Visits and posts to online community are positively related to the response rate.
Purpose
The concept of information security culture, which recently gained increased attention, aims to comprehensively grasp socio-cultural mechanisms that have an impact on organizational security. ...Different measurement instruments have been developed to measure and assess information security culture using survey-based tools. However, the content, breadth and face validity of these scales vary greatly. This study aims to identify and provide an overview of the scales that are used to measure information security culture and to evaluate the rigor of reported scale development and validation procedures.
Design/methodology/approach
Papers that introduce a new or adapt an existing scale of information security culture were systematically reviewed to evaluate scales of information security culture. A standard search strategy was applied to identify 19 relevant scales, which were evaluated based on the framework of 16 criteria pertaining to the rigor of reported operationalization and the reported validity and reliability of the identified scales.
Findings
The results show that the rigor with which scales of information security culture are validated varies greatly and that none of the scales meet all the evaluation criteria. Moreover, most of the studies provide somewhat limited evidence of the validation of scales, indicating room for further improvement. Particularly, critical issues seem to be the lack of evidence regarding discriminant and criterion validity and incomplete documentation of the operationalization process.
Research limitations/implications
Researchers focusing on the human factor in information security need to reach a certain level of agreement on the essential elements of the concept of information security culture. Future studies need to build on existing scales, address their limitations and gain further evidence regarding the validity of scales of information security culture. Further research should also investigate the quality of definitions and make expert assessments of the content fit between concepts and items.
Practical implications
Organizations that aim to assess the level of information security culture among employees can use the results of this systematic review to support the selection of an adequate measurement scale. However, caution is needed for scales that provide limited evidence of validation.
Originality/value
This is the first study that offers a critical evaluation of existing scales of information security culture. The results have decision-making value for researchers who intend to conduct survey-based examinations of information security culture.
•Intrapersonal and interactional psychological empowerment can develop in HROSCs.•Participation is not a necessary condition for intrapersonal empowerment in HROSCs.•Posters and lurkers have a ...similar degree of intrapersonal empowerment in HROSCs.•Posters experience higher degree of interactional empowerment than lurkers in HROSCs.•Intensity of posting is associated only with interactional dimension of empowerment.
Participation in health-related online support communities plays an important role in the psychological empowerment of people who are faced with health problems. Research has suggested that important differences exist in terms of psychological empowerment depending on the form and intensity of participation in such domains by showing that users who contribute to health-related online support communities by posting messages (posters) generally experience greater benefits in terms of intrapersonal empowerment, compared to participants who only read messages (lurkers). However, as yet, very little is known about how the often-neglected interactional aspect of psychological empowerment is associated with participation in these online domains. Thus, the aim of this study was to explore how different forms and intensity of participation in health-related online support communities are associated with both dimensions of psychological empowerment. Drawing on a nonprobability sample of 616 participants in two health-related online support communities, the analysis of the data, obtained with an online questionnaire, revealed that posters scored significantly higher in degree of interactional empowerment than lurkers, whereas no difference was observed in terms of intrapersonal empowerment. In addition, high posting frequency was significantly associated with a high level of interactional empowerment but not intrapersonal empowerment. The study suggests that to better understand the empowering potential of participation for users of health-related online support communities, it is important to distinguish not only between various forms of participation but also between different aspects of psychological empowerment.
Objective
Informational social support is one of the main reasons for patients to visit online health communities (OHCs). Calls have been made to investigate the objective quality of such support in ...the light of a worrying number of inaccurate online health-related information. The main aim of this study is to conceptualize the Quality of Informational Social Support (QISS) and develop and test a measure of QISS for content analysis. A further aim is to investigate the level of QISS in cancer-related messages in the largest OHC in Slovenia and examine the differences among various types of discussion forums, namely, online consultation forums, online support group forums, and socializing forums.
Methods
A multidimensional measurement instrument was developed, which included 20 items in a coding scheme for a content analysis of cancer-related messages. On a set of almost three million posts published between 2015 and 2019, a machine-learning algorithm was used to detect cancer-related discussions in the OHC. We then identified the messages providing informational social support, and through quantitative content analysis, three experts coded a random sample of 403 cancer-related messages for the QISS.
Results
The results demonstrate a good level of interrater reliability and agreement for a QISS scale with six dimensions, each demonstrating good internal consistency. The results reveal large differences among the social support, socializing, and consultation forums, with the latter recording significantly higher quality in terms of accuracy (M = 4.48, P < .001), trustworthiness (M = 4.65, P < .001), relevance (M = 3.59, P < .001), and justification (M = 3.81, P = .05) in messages providing informational social support regarding cancer-related issues.
Conclusions
This study provides the research field with a valid tool to further investigate the factors and consequences of varying quality of information exchanged in supportive communication. From a practical perspective, OHCs should dedicate more resources and develop mechanisms for the professional moderation of health-related topics in socializing forums and thereby suppress the publication and dissemination of low-quality information among OHC users and visitors.
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