Introduction

The World Health Organization defines health literacy as "the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health." Unfortunately, people with limited health literacy tend to have lower efficacy for maintaining healthy behaviours, leading to increased incidence of chronic diseases and health care costs. Nowadays, more and more information are distributed digitally, and the term digital health literacy can be used to describe health information in this context [1].

The value of digital health lies in the use of information and communication technologies for improving patients’ health and well-being and the delivery of health care services. Poor accessibility of health information in digital formats can lead to multiple diagnostic, therapeutic, and prognostic harms, which have an impact on patient safety [2].

Misinformation is defined as information, which is distributed with no intention to cause harm, in contrast to disinformation, where there is an intention to deceive. The spread of misinformation occurs through social contacts or social media [3]. Everyone has now become a potential dissemination source with the capacity to share whatever they believe regardless of its reliability [4]. Moreover, the interconnectivity of the digital era means that the rapid spread of misinformation has a corrosive power on the individual’s short-, medium- and long-term health outcomes [3].

Previous studies identified many factors that play essential roles in determining an individual’s online information-seeking behaviour, such as demographic characteristics (age, gender, educational, socioeconomic, and employment status) and health status [5]. Elderly patients are reluctant to use the Internet, which is consistent with offline gender-based health-seeking behaviour [6]. Individuals who are better educated, employed, and of a higher social class prefer to use online websites as a source of health information [7]. Those with poor or fair health, chronic conditions, and a long-term illness or disability were more likely to visit health sites than those who reported better health [8]. A study on rural digital immigrants in China [9] reported that poor information skills, lack of health information literacy, and low readability of online health information are significant barriers for digital immigrants to seeking health information via the Internet.

Although the Internet offers many advantages to consumers of online health information, searching for specific information can cause many issues concerning the credibility of the information provided [10]. Finding high-quality sites can be challenging, and there are problems with author identification, completeness, and accuracy of the information provided [11,12].

Evaluating the reliability of online health information has been a central issue in consumer health informatics for many years [13]. However, a recent review done in Finland (2020) [14] showed that many adolescents face a challenge in evaluating the credibility of health-related online information. Although they understand that online information is not always to be trusted, many remain unsure of how to evaluate its credibility [15–17].

A 2020 systematic review study [18] identified 17 tools for assessing the trustworthiness of online information, all published between 1997 and 2018 (S1 Table). The tools were developed for different purposes, from a general quality assessment of medical information to detailed analyses. However, the development process of the tools was poorly described. Some tools lacked essential criteria for assessing the trustworthiness of medical information and were not designed for a lay audience.

The criteria used for evaluating online website information in the literature vary depending on the population and context but often include website position in search results, picture quality; celebrity endorsement; website readability; website authorship; website credentials, and consistency with search intentions [19]. A study done in the United States [11] identified twenty-five evaluation criteria (S2 Table). However, using the evaluation criteria for online health information depends on consumers’ health literacy and educational level [19]. For example, Mackert et al. showed that individuals with low health literacy used "position in search results, quality of pictures, celebrity endorsement, and website authorship as criteria to evaluate online health information [13].

A 2019 systematic review [11] done in the United States identified the common indicators used by internet consumers to evaluate the quality of online health information, which are related to three aspects of online information: source, content, and design. Studies done by Fogg et al. (2003) [20] and Walthen and Burkell (2002) [21] reported that most consumers of online information depend on simple methods for credibility evaluation, relying on site presentation and visual design rather than considering content and source presentation.

Accordingly, many information processing theories have been used to explain information-seeking behaviours for users’ credibility assessment of web-based information [22]. For example, the dual processing model stated that internet consumers use either central or peripheral strategies for information evaluation depending on high or low motivational status, respectively [23]. This was supported by the limited capacity model of message processing, which stated that people usually process part of the message provided as they have a limited cognitive capacity for message processing [24]. Additionally, the information-foraging theory claims that whenever feasible, humans will choose behaviours that ’’tend to optimize the utility of information gained as a function of interaction cost’’ [25,26]. Conclusively and taken together, online information seekers tend to use strategies that minimise their cognitive and time investments to cope with the high load of available information.

Many interventions exist targeting a lay person’s ability to find reliable online information. For example, a 2014 study [27] identified the importance of educational programs, interactive workshops, collaborative learning, health literacy curriculum, community outreach, and an online portal with support via videoconferencing. All these interventions aim to teach people how to navigate online, then measure changes in knowledge and internet skills for evaluation purposes.

There is a need to think about a new form of social behaviour surrounding information-seeking that accounts for economic and social effects and requires a change in how science and information professionals approach the dissemination of knowledge. Above that, actions to combat misinformation must be planned and carried out with the support of patients and public.

Materials and methods

Ethics approval and consent to participate is not required for conduction of this integrative systematic review. As this study is solely based on the analysis of previously published anonymous data and contain no identifiable individual person’s data, therefore consent to participate is not applicable.

This systematic review will be reported based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) S1 Checklist [28].

Eligibility criteria

Table 1 show the inclusion and exclusion criteria with the justification.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 1. Inclusion and exclusion criteria with justification.

https://doi.org/10.1371/journal.pone.0284028.t001

Data management

Duplicates will be removed using Endnote Reference Management Software (Clarivate), and additional duplicates not identified by the Endnote function can be removed manually. The deduplicated data can then be imported into Covidence (Veritas Health Innovation Ltd), a review-management software program that operates in partnership with Cochrane Collaboration and allows multiple reviewers to work on study selection simultaneously and independently.

Results and discussion

Patients or the public will be involved in synthesising and interpreting the study results. The findings of this research will be helpful for lay people to identify the gaps of implemented interventions and address the issues related to the barriers. Policymakers can also use the research findings to promote scaling up of the implemented interventions globally and facilitate designing of future approaches based on technology and innovations.

The results of the study will be disseminated through peer-reviewed publications, academic conferences, and to all patients and the public involved in this study. The findings will be disseminated to the public through local media (Radio) and newspapers articles.

Conclusions

The findings of this paper will inform the design of future user-centred interventions tailored to patients and public needs.

Supporting information