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The Impact of Online Healthcare Communities on the Patient – Doctor Relationship and attitude
Abstract: This preliminary research investigates the effects of healthcare information delivered and shared on Internet through online health communities on patients – physicians’ relationships and patients’ attitude towards their physician. To do so, we surveyed 567 e-health communities’ members. Our results highlight that members who frequently visit online health communities have shown a higher trust towards their physician than other members. Additionally, our data enhance that the members suffering from a chronic disease perceive they have a better relationship with their physician and a higher trust towards their physician than the others. Keywords: E-health, Online patient community, patient - physician relationship, trust, attitude.
Track: Online Marketing and Social Media
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1. Introduction Fundamental changes inherent in the Web 2.0 lead people, either patients or not, to use online health communities to get and exchange information on health topics. According to Harris Interactive Poll, nearly 74 percent of all adults have searched online for health-related information in 2011. In consequence of the Internet and specifically the Web 2.0 upsurge, the last decade has seen the development of both generalist and more specific online health communities, which are now widely used. The possibility for patients, citizens, physician and health care systems to create, comment, share and more basically have access to medical information and data have initiated a ‘healthcare revolution’ which challenges the patientphysician relationship. Online health communities have given to people, either educated or not, the opportunity to have access to elaborate medical information which used to be inaccessible. Today, these crucial changes put into the forefront and challenge the patientphysician relationships as well as the patient’s attitude towards his physician. In spite of the considerable development of e-health in general and of online health related groups or communities in particular, little empirical research have been done to date on the relationship and attitude linking the patient to his physician. This research aims at filling this gap and examines both the attitude and the relationship between online health participants (members) and their physicians. Specifically, it aims at assessing whether participating frequently to an online health community alters the attitude and relationships between the now ‘consumers’ and their physicians. It also aims at assessing differences on these variables between two interesting populations: members suffering from a chronic disease (e.g., cancer, spondylitis, diabetes, and o orphan diseases) versus other members. To do so, we developed a survey and have been interviewing over five hundred members ‘active’ on e-health communities in France (we define here as ‘active’, people declaring reading information on online communities or as participating to these communities, while posting information for example over the year). Precisely, we investigate two key relational variables: members’ perceived trust on the one hand and members’ perceived quality of their relationship with their physician on the other hand. We also examine the shift in members’ attitude towards their doctors. Overall we propose and test six hypotheses. The paper is organized as follows: we firstly introduce the conceptual framework and research hypotheses. We then present the method and the results. Lastly, we discuss the limitations and the recommendations for future research. 2. Conceptual framework and research hypotheses As mentioned by Johnston, Worell, Di Gangi and Wasko (2013), social media associated with Web 2.0 technologies are fundamentally changing the way individuals manage their healthcare. Over the past decade, the Internet and Web 2.0 have given the patient the opportunity to find and exchange information on online communities, Wikipedia, blogs…etc. Similarly, internet related technologies have been influencing the way in which physicians practice medicine. A recent survey, carried out by the Mayo Clinic (2012), showed that quite 26% of all American hospitals participate in social media, by using YouTube (46%), Facebook (84%), Twitter (64%) and Blogs (12%). Overall, in North America, 87% of major health infrastructures have an official social media presence on Internet (Mayo Clinic, 2012). Today, online health communities enable people with similar pathologies to connect, share their experiences, information and find mutual support. In line with Brown and Duguid (2001), Wasko and Faraj (2005) and more recently Johnston et al. (2013), we define online health communities as a specialized subset of online communities which consist of large, geographically dispersed groups of individuals who may or may not know each other, but share a common interest. Online health communities make it possible for people, either patient or not, to have access to specific medical information they usually do not have access 2
to. They not only help patients to gather information, but also offer to a wide audience access to a huge amount of clinical health information, guidance on conditions treatment alternatives and experiences of others suffering from similar conditions (Yang, Tan and Peng, 2011). Over the past decade, scholars have found that the use of Internet for health information, through online communities, provide more benefits than drawbacks for patients (Potts and Wyatt, 2002; Schwartz et al., 2006). Yet, regarding physicians’ point of view of the use of online health communities, the benefits appear to more controversial (Murray et al., 2003). Though, Wald, Dube and Anthony, (2007) have found that e-health communities convey accurate medical information and that it may make patients better informed. Street, Makoul, Akora and Epstein (2014), indicate that better informed consumer tend to have better health outcomes and use health services in a more appropriate way. The rise of the Internet health patient has also lead to reconsider the patient-physician relationships. It can be seen as an opportunity to ‘share the burden of responsibility for knowledge’ and therefore, to improve the physician-patient relationship (Wald et al., 2007). Johnston et al. (2013) find that participating in an online health community leads to patient positive empowerment. Hesse, Hansen, Finholt, Munson, Kellogg and Thomas (2010) consider that Web 2.0 medicine lead patients to be more proactive and that this new paradigm will enable citizens to work with medically trained professionals to extend life. Overall, the medical information, which used to be the ‘apanage’ of the physician, has moved from the physician towards the patients. This shift challenges the patient-physician relationship and might be seen as a means to reconsider it and strengthen it. This is all the more interesting that scholars have shown that a sustained relationship with a physician is associated with better treatment outcomes (O’Malley & Forrest, 2002; Parchman & Burge, 2003). Consistently with the above mentioned literature and suggestions, we expect that H1: When an individual becomes more participatory in an online health community, his perception of the quality of his relationship with the physician is increased. Specifically, we expect that patient’s trust, and attitude towards his physician should increase, since they have more information and feel more supported. Therefore, we propose that H2: When an individual becomes more participatory in an online health community, his trust towards his physician is increased. Additionally, we expect that H3: When an individual become more participatory in an online health community, his attitude towards his physician is increased. Consistently with the literature also, indicating that people undergoing a chronic disease, like cancer, diabetes or orphan disease, should be more likely to search for information on e-health communities, we expect that members undergoing a chronic disease are more likely to perceive their trust and relationship with their physicist as positive. Therefore we hypothesize that H4: Online health community member undergoing a chronic disease will have a higher perception of the quality of his relationship with the physician than other members. H5: Online health community member undergoing a chronic disease will have a higher trust towards his physician than other members. H6: Online health community member undergoing a chronic disease will have a more favourable attitude towards his physician than other members. 3. Research method 3.1. Survey sample To test our research hypotheses, we developed an online survey. 837 French citizens were contacted during 2014 through online communities such as PatientsWorld or Carenity, which are major E-health communities in France. Out of these 837 people, 567 (67%) answered the online questionnaire, among which nearly 25% declared to suffer from a chronic disease. Nearly 60% of the respondents were women. This is consistent with Ybarra and Suman ( 2005) the findings indicating that women are significantly more likely than males to use the 3
Internet as a source for health information. The average age of the respondents is 30 years old, ranging from 18 to 67 years old. Data were collected on an anonym basis. 3.2. Measurement Relying on the marketing literature, we have adapted scales to online health community patients to assess their trust, perceived quality of the relationship and attitude towards their physicians. Each construct was composed of several items measured on seven points Likerttype scales anchored by 1 = strongly disagree and 7 = strongly agree. The trust scale was adapted from Dooney and Cannon (1997); the patient’s – physician relationship, from Dant, Weaven and Baker’s scale (2009) and the attitude towards the doctor, from Oliver’s (1980). Patient’s trust was measured on four items reflecting the multidimensionality of trust (Donney and Cannon, 2007); patient’s perceived quality of the relationship, was assessed on seven items; and the patient’s attitude towards his physician on four items. The data were factor analysed so as to assess the dimensionality and consistency of the scales. The reliability of each scale was assessed thanks to the empirical indicator of Cronbach alpha. 3.3. Method To test our first set of hypotheses (H1 to H3), we ran t-tests for each of the following construct, a) patient perceived relationship with the physician; b) patient’s attitude towards the physician and c) patient’s perceived trust towards his physician, for two populations, i) members declaring they do not or poorly interact with online health communities on the one hand, and ii) members declaring they frequently interact with online health communities on the other hand. We consider as frequent members, those who declare to interact over six times a year with their online health community. Similarly, to test our second set of hypotheses (H4 to H6) we compared means for the three above mentioned constructs for respectively members declaring they have a chronic disease versus other members. 4. Results 4.1. Factorial analysis results Before running the factorial analysis, we checked that the data could be factor analysed thanks to the Bartlett test of sphericity and the Kaiser-Meyer-Olkin measure of sampling adequacy. Both reveal to be good: the Bartlett’s test is significant at a p < .001 level, and the KaiserMeyer-Olkin’s value is of .942. We then ran a factorial analysis with varimax rotation. This led us to the identification of three factors accounting for 71.99% of the total variance. The first factor, accounting for 27.03% of the variance can be defined as a ‘quality of the patient-physician relationship’ factor (cf. Table 1). The second factor, which accounts for 26.62% of variance, reflects the patient’s attitude towards the physician. The third one, which accounts for 18.34% of variance, expresses the trust the patient has towards his physician. Consistently with our expectations, the factors analysis highlights the existence of the three main expected constructs. The reliability of the scales (cf. Table 1), also proves to very satisfactory for the three constructs (Cronbach alphas are higher than 0.8), according to De Vellis (2003) classification. 4.2. T-tests results Results for H1, H2 and H3 Consistently with our expectations, the t-tests results indicate that frequently reading or participating to online health communities significantly impacts the patient’s trust towards his physician (m163= 6.08 vs. m134=5.42; p < 0.05). Therefore, H2 is supported. Trust, a key relational variable (Singh and Sirdeshmukh, 2000), significantly increases with the frequency 4
of interactions with the online health community. Considering the perceived quality of the relationship, the data highlight that been a frequent user does not alter the patient’s perceived quality of the relationship towards his physician at a p < 0.05. Similarly, the data do not reveal a significant differences regarding the attitude towards the physician for frequent versus less frequent members, suggesting that frequently reading or participating to online community does not affect member’s attitude towards their physician at a p < 0.10 level. Therefore, H1 and H3 are not supported by our data here. Results for H4, H5 and H6 Now, considering patients experiencing a chronic disease vs. others members, the data indicate that a difference exists between these two populations regarding their perception of the quality of the relation they have with their physician. Precisely, the data highlights that those who suffer from a chronic disease perceive their relationship with their physician to be of better quality than the other members of the online health community (m118= 5.93 vs. m407=5.70; p < 0.05). H4 is supported by our data. Similarly, the data underline that the members declaring having a chronic disease report to trust their physician more than the other members (m37= 6.75 vs. m51=5.31; p < 0.05). H5 is also supported. Yet, regarding the attitude towards the physician, we do not find any significant difference at a p < 0.05 between the two populations. Therefore, H6 is not supported here. 5. Discussion, limitations and future research This research presents several contributions. Overall, three of the six hypotheses we proposed are validated and provide support for the use of e health communities to strengthen the patient-physician relationship. Firstly, this study shows that online health communities strengthen specific aspects of the patient-physician relationship. Interestingly, it reveals that being a frequent member of ehealth community or being a member having a chronic disease reinforces one’s trust towards one’s physician. In line with previous researches (Erderm and Harrison-Walker, 2006), it confirms the importance of e-health communities as a means to reinforce patient’s trust towards their physician. This is why we believe online health communities should be used so as to tighten the ‘bonds’ between the patient and his physician, in two critical situations; when a patient starts a relationship with a new physician; or when he learns he suffers from a chronic disease. These findings also suggest that physicians should commit in e-health communities to build patient-internet-physician profitable relationships. Secondly, the data highlight that the perception of the member’s quality of his relationship with his physician is not altered whether been a frequent vs. non frequent user. However, the data show that this perception his significantly higher for those who suffer from a chronic disease versus the other members. Therefore, this confirms that been a member with a chronic disease alters the patient-physician relationship, and that more importantly, increases the patient’s perceived quality of this relationship. Thirdly considering the impact of e health communities on members’ attitude towards their physician our data reveal that being either a frequent member or a member with a chronic disease does not alter patient’s attitude towards the doctor. In view of its preliminary nature, this research experiences limitations but also paves the way for future research. Firstly, replications are needed to increase the external validity of our findings. Secondly, we think other relational variables should be investigated like patient’s satisfaction or commitment, among others. Thirdly, we expect the findings to be altered across countries, dependently of the medical system, i.e. for example, medical systems offering the opportunity to have easily access to a physician versus those which do not. Last but not least, we believe other researches should explore moderating variables such as the pathology and the gravity of the disease. 5
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Appendix Item I consider my relationship with the physician as ‘cordiale’ I consider my relationship with the physician as sympathetic I consider my relationship with the physician as satisfactory I consider my relationship with the physician as helpful I consider my relationship with the physician as satisfactory I consider it is a good idea to have visited my physician I did the right choice when I have chosen to go to this physician I consider this physician is a good physician I consider this physician as one of the best in his field I would not recommend to go to this physician My attitude towards this physician is favorable Regarding your attitude towards your physician, you would say that you do not want to go and visit this physician in particular in the near future Regarding your physician, you would say, he is not always honest Regarding your physician, you would say, I am not happy when visiting him Regarding your physician, you would say, it is important to be critical with him because I do not trust him Regarding your physician, you would say, if you could, you would choose another one Cronbach alpha
F1 .832 .828 .770 .707 .637 .599
F2
F3
.567 .822 .809 .771 .726 .724 .781 .759 .754 .565 .927
.910
.813
Table 1. Factor Analysis Results with Varimax Rotation
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