Cyberchondria

Ryen W. White, Eric Horvitz
2009 ACM Transactions on Information Systems  
The World Wide Web provides an abundant source of medical information. This information can assist people who are not healthcare professionals to better understand health and illness, and to provide them with feasible explanations for symptoms. However, the Web has the potential to increase the anxieties of people who have little or no medical training, especially when Web search is employed as a diagnostic procedure. We use the term cyberchondria to refer to the unfounded escalation of
more » ... about common symptomatology, based on the review of search results and literature on the Web. We performed a large-scale, longitudinal, log-based study of how people search for medical information online, supported by a survey of 515 individuals' health-related search experiences. We focused on the extent to which common, likely innocuous symptoms can escalate into the review of content on serious, rare conditions that are linked to the common symptoms. Our results show that Web search engines have the potential to escalate medical concerns. We show that escalation is associated with the amount and distribution of medical content viewed by users, the presence of escalatory terminology in pages visited, and a user's predisposition to escalate versus to seek more reasonable explanations for ailments. We also demonstrate the persistence of postsession anxiety following escalations and the effect that such anxieties can have on interrupting user's activities across multiple sessions. Our findings underscore the potential costs and challenges of cyberchondria and suggest actionable design implications that hold opportunity for improving the search and navigation experience for people turning to the Web to interpret common symptoms. Health and Fitness (http://health.msn.com) provide answers to such questions as whether concerning symptoms might indicate the onset of a serious, acute, or chronic condition, or whether such fears are unfounded. However, the use of Web search as a diagnostic methodology-where queries describing symptoms are input and the rank and information of results are interpreted as diagnostic conclusions-can lead users to believe that common symptoms are likely the result of serious illnesses. Such escalations from common symptoms to serious concerns may lead to unnecessary anxiety, investment of time, and expensive engagements with healthcare professionals. We use the term cyberchondria to refer to the unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web. The large volumes of medical information on the Web, some erroneous, may mislead users with health concerns. Much has been written in the medical community about the unreliability of Web content in general [Eysenbach 1998; Jadad and Gagliardi 1998; or content about specific conditions such as cancer [Biermann et al. 1999 ]. Indeed, studies have shown that, although 8 in 10 American adults have searched for healthcare information online, 75% refrain from checking key quality indicators such as the validity of the source and the creation date of medical information [Pew Internet and American Life Project 2007]. Berland and colleagues [2001] suggest that medical information present on Web sites is generally valid, although they also find that it is likely to be incomplete. Eysenbach and colleagues [2002] systematically reviewed health Web site evaluations and found that the most frequently used quality criteria included accuracy, completeness, and design (e.g., visual appeal, layout, readability). In their review, the authors noted that 70% of the studies they had examined concluded that the quality of health-related Web content is low. In addition, Benigeri and Pluye [2003] show that exposing people with no medical training to complex terminology and descriptions of medical conditions may put them at risk of harm from self-diagnosis and self-treatment. These factors combine to make the Web a potentially dangerous and expensive place for health seekers. The information obtained from healthcare-related searches can affect peoples' decisions about when to engage a physician for assistance with diagnosis or therapy, how to treat an acute illness or cope with a chronic condition, as well as their overall approach to maintaining their health or the health of someone in their care. Beyond considerations of illness, information drawn from the Web can influence how people reflect and make decisions about their health and wellbeing, including the attention they seek from healthcare professionals, and behaviors with regard to diet, exercise, and preventative, proactive health activities. In this article, we present the findings of a log-based study of anonymized data about online searches for medical information drawn from a large set of data on Web search behavior shared voluntarily by a large number of users of Web search engines. We focus particularly on the association between the input of search terms that describe common symptoms and shifts of focus of attention to serious illnesses, illnesses that are rarely the causes of such common complaints. We contrast medical search sessions that show a trajectory from basic
doi:10.1145/1629096.1629101 fatcat:2nzzrent5vcxzj432rz5tiysaq