Background/Objectives: In China, discussing sexual and reproductive health remains taboo, often preventing patients from seeking care or advice on sensitive topics. Online medical consultations (OMCs) offer a unique platform for patients to discuss these concerns more openly. This study investigates how patient-centered communication (PCC) practices, including conversational themes and the use of politeness markers, influence patient satisfaction in Chinese OMCs, with a focus on sensitive gynecology and andrology topics. Methods: This study used a mixed-methods approach, including theme-oriented discourse analysis (TODA) and content analysis on 328 OMCs (179 in andrology, 149 in gynecology) collected from Dr. Chunyu, a popular Chinese online healthcare platform that provides medical consultations, from 19 to 22 March 2022. Logistic regressions were conducted to assess the influence of politeness markers on patient satisfaction, while TODA examined PCC practices in sensitive conversations. Results: TODA identified two key themes in PCC that enhanced patient satisfaction: normalizing sensitive health concerns and fostering collaborative decision-making. Politeness markers, specifically the use of polite words and expressions of best wishes, were positively associated with patient satisfaction. However, downtoners, emojis, and sentence-final particles showed no significant effect. There were no significant differences in the impact of politeness markers between gynecology and andrology consultations. Conclusions: This study highlights the importance of PCC and politeness markers in improving patient satisfaction in OMCs, especially when addressing sensitive sexual health topics.

It is known that older adults are more susceptible to misinformation, and older adults sharing health misinformation is a growing concern. This study explores the factors influencing health misinformation sharing and relational correction among Chinese older adults from a cultural perspective. Guided by the PEN-3 cultural model, we conducted focus groups and in-depth interviews with 79 participants in China to understand the cultural and contextual factors of misinformation sharing. We found that (a) older adults actively shared health misinformation influenced by negative factors such as values of familial ties, need for respect, reciprocity, and initiation of conversation; (b) existential factors such as fact-checking tendency; (c) positive factors such as fatal information avoidance, political identify, awareness of marketing targeting, and social responsibility. Additionally, we found that older adults tend to switch to a silent mode of relational correction for factors such as harmony and face. This research extends the model's applicability and provides localized insights for developing culturally sensitive health communication strategies to mitigate the spread of health misinformation.

The care/harm moral foundation is a key antecedent of health behavior change, and care-based moral appeals, persuasive messages that integrate the care/harm foundation with specific health behaviors, have demonstrated effectiveness in health promotion campaigns. However, the role of care-based moral appeals within pictorial warnings (PWs), a widely implemented tobacco control strategy, remains understudied. Moreover, little is known about how smokers from diverse sociocultural backgrounds respond to the same type of care-based moral appeals, particularly in countries that have yet to adopt PWs on cigarette packaging. To address these gaps, this study reports secondary analyses of two randomized multi-message experiments using real-world tobacco control campaign messages ( K _US = 319, K _China = 510) among American and Chinese smokers ( N _US = 1,392, N _China = 2,306). Each participant viewed six PWs randomly selected from a large stimulus pool and rated their perceived message effectiveness, yielding 22,188 total observations. Cross-classified multilevel regression analyses revealed that smokers in both countries perceived shocking care appeals as more effective than non-shocking care appeals and other PWs that did not employ care-based moral appeals. Non-shocking care appeals were also rated more effective than the control category. Significant cross-level two-way interactions emerged between message features (shocking care appeals) and respondents’ care/harm foundation endorsement, as well as between country and care/harm foundation. The three-way interaction was non-significant. Our findings underscore the effectiveness of care-based moral appeals in tobacco control campaigns and contribute to theoretical inquiries in message effects research from global and comparative perspectives

Despite China’s ratification of the World Health Organization’s Framework Convention on Tobacco Control in 2005 (Huang, 2014), tobacco control efforts have stagnated, including delayed implementati...

Introduction: Vaping public education campaigns are a central prevention strategy for young adults (YAs), but message effectiveness varies widely and formative testing typically evaluates one message attribute at a time. This study examined how four perceptual dimensions—cognitive engagement, social relevance, emotional arousal, and emotional valence—relate to perceived message effectiveness (PME), and whether multiple combinations of these dimensions correspond to similarly high PME. Methods: In a cross-sectional online message-testing study conducted from March to April 2025, 540 U.S. YAs who vape each evaluated 15 messages randomly sampled from a corpus of 229 text-image vaping public education messages, yielding 8,100 message evaluations. Cross-classified multilevel models estimated associations between each perceptual dimension and PME. An Explainable Boosting Machine probed nonlinear associations, and k -means clustering of high-predicted-PME perceptual configurations identified distinct profiles. Analyses were conducted in 2026. Results: Cognitive engagement ( b = 0.20, 95% CI [0.18, 0.22]) and social relevance ( b = 0.15, 95% CI [0.13, 0.17]) showed the strongest associations with PME, followed by emotional arousal ( b = 0.06, 95% CI [0.04, 0.08]); emotional valence showed no linear association ( b = 0.00, 95% CI [−0.02, 0.02]). The Explainable Boosting Machine revealed a U-shaped valence pattern, with higher predicted PME at both the negative and positive ends of the scale. Clustering yielded five distinct perceptual profiles with similarly high predicted PME (4.10–4.25). Conclusions: Multiple perceptual configurations correspond to similarly high PME, supporting a configurational approach to formative message testing rather than a single optimal message formula.