Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: With the increasing concern of Healthy China and the development of information technology, mobile health enables patients access health information and interacting with doctors anytime and anywhere. Since the success of mobile health would depend on the adoption of patients, examining patients’ willingness to use it is considered critical. Objective: This study aims to explore the determinants of mobile health services adoption among Chinese patients by an extended TAM with trust and perceived risk. Methods: We conducted a questionnaire-based survey in three large Chinese hospitals, and analyzed the data with structural equation model. Results: The results reveal that the proposed model fits well. Specifically, trust, perceived usefulness and perceived ease of use positively correlate with mobile health services adoption. While, privacy risk and performance risk negatively correlate with the patients’ trust and adoption intention toward mobile health. In addition, age and chronic condition of patients could predict their trust level and adoption intention towards mobile health respectively. Conclusions: We conclude that TAM works for the context of mobile health adoption in general, though the significance has declined. Supplementary to technical factors, trust and perceived risk are critical in explaining mobile health services adoption among Chinese patients.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Nowadays, patients are seeking physician information more frequently via the Internet. Physician Rating Websites (PRWs) have been recognized as the most convenient way to gain insight and detailed information about specific physicians before consultation. However, little is known about how the information provided on PRWs may affect patients’ decisions to seek medical advice. Objective: This study aims to examine the relationship between the online reputation of physician and their perceived efforts on PRWs, and their aggregated number of patients consulted with online. Methods: A model, based on social exchange theory, was developed to analyze the factors associated with the number of online patients. A three-wave data collection exercise, covering 4041 physicians on China’s Good Doctor Website, was conducted during the months of February, April and June, 2017. Data was analyzed using a liner regression model and fixed effect model. Results: The adjusted R-squared in the linear regression model was 0.55 and 0.57, while in the fixed effect model, it was seen to be 0.75. Both the linear regression and fixed effect models yielded a high fit. A positive effect of physicians’ effort on the aggregated number of online patients was identified in all models (0.29, 0.37; 0.21; p<0.01). The proxies of physicians’ reputations indicated different results, with the physicians’ homepage reviews (0.43, 0.46; 0.166; p<0.01) and number of votes received (0.33, 0.27;0.27; p<0.01) being seen as positive. Virtual gifts were not significant in all models, while thank-you letters were only significant in the fixed effect model (0.09, p<0.05). The effort of physicians’ online is positively associated with their aggregated number of patients consulted, while the effect of a physician’s reputation remains unfixed. The control effect of physician’s gender, position and hospital’s level was not significant in all linear regressions. Conclusions: Both the effort and reputation of physicians’ online contribute to the increased number of patients consulted with online, however, the influence of a physician’s reputation varies. This may imply that physicians’ online effort and reputation is critical in attracting patients online, and strategic manipulation of physician profiles is worthy of study. Practical insights are also discussed.

Background: In recent years, China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. Asymmetric information between patient and physicians is one of the most critical enablers in this phenomenon, but the Web has become the primary resource for Chinese Internet applications to learn about health information and could potentially play a role in this pathway to patient–physician interaction and patient–physician trust. While considerable attention has been paid in some countries, there are few researches about China’s situation for this issue. The purpose of this quantitative study was to examine the influence of online health information and the online guidance of doctors in patient health information literacy on patient–physician interaction and patient–physician trust in China. Methods: A web-based survey was conducted to collect data from online applications with health problems. A structural equation modeling was used to analyze the data to test the hypotheses. A total of 446 participants from the Tongji Hospital in Wuhan and Huazhong University of Science and Technology hospital participated in the study. Results: Our analysis shows that the usefulness of online health information and the online guidance of doctors both significantly influence the trust of the patient toward physicians and interaction with physicians. Furthermore, the patient–physician interaction also has a significant impact on the patient–physician trust. Conclusions: There are many studies on the influence of online health information on the doctor–patient relationship, whereas a little research has examined this relationship between health information online support from doctors and patient–physician interaction by quantitative empirical analysis. This study also explores the online guidance role of doctors and whether doctor–patient communication will affect the trust of doctors and patients. The practical implications of this study include an improved understanding of the function of online health information and potential impacts regarding the interaction with physicians and trust toward physicians that can be used to resolve conflicts between doctors and patients.

Over-prescription of antibiotics is prevalent all over the world, contributing to the development of antibiotic resistance. The importance of understanding how physicians prescribe antibiotics is increasingly highlighted for the purpose of promoting good practice. This study aimed to identify factors that shape the antibiotic prescribing behaviors of physicians in primary care based on the theory of planned behavior (TPB). Data were collected from 503 prescribers within 65 primary care facilities in Hubei, tapping into four behavioral aspects leading to antibiotic prescribing based on TPB, namely, attitudes (the degree to which a prescriber is in favor of the use of antibiotics), subjective norms (perceived social pressure to which a prescriber is subject in relation to antibiotic prescriptions), perceived control of behaviors (how easy a prescriber feels in making a rational decision on antibiotic prescriptions) and intentions (the degree to which a prescriber is willing to prescribe antibiotics). A total of 440,268 prescriptions were audited to assess physician antibiotic prescribing practices. The four behavioral constructs were further linked with physician’s actual use of antibiotics using structural equation modelling (SEM) based on TPB. On average, 40.54% (SD = 20.82%) of the outpatient encounters resulted in a prescription for an antibiotic given by the participants and 9.81% (SD = 10.18%) of the patients were given two or more antibiotics. The participants showing a more favorable attitude toward antibiotics had a higher intention to prescribe antibiotics (β = 0.226, p < 0.001) and a lower intention to reduce antibiotic use (β = − 0.211, p < 0.001). Those who perceived lower social pressure (β = 0.113, p = 0.030) and higher control over prescribing behaviors (β = 0.113, p = 0.037) reported a higher intention to reduce the use of antibiotics. However, such intention did not translate into prescribing practice (p > 0.05), although stronger perceived behavioral control was directly linked with lower antibiotic prescriptions (β = − 0.110, p = 0.019). Weaker perceived behavioral control was evident in the participants who showed a less favorable attitude toward antibiotics (β = 0.128, p = 0.001). Antibiotic prescribing practice is not under the volitional control of prescribers in primary care in China. Their rational prescribing practice is likely to be jeopardized by perceived weak control over prescribing behaviors.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Social media has penetrated all walks of life. Chinese Healthcare Institutions are increasingly utilizing social media to connect with their patients for better health service delivery. Current research has focused heavily on the use of social media in developed countries, with few exploring its usage in the context of developing countries, such as China. This study examines China’s best hospitals, as recognized by The National Health and Family Planning Commission (NHFPC) of the People’s Republic of China, mapping out the landscape of current social media usage by hospitals when engaging with patients. Objective: This study aims to examine China’s best hospitals, as recognized by The National Health and Family Planning Commission (NHFPC) of the People’s Republic of China, and to map out the landscape of current social media usage by hospitals when engaging with patients. Methods: We examined the best 705 hospitals in China, collecting and analyzing their usage of popular Chinese social media applications, Sina Weibo and WeChat. Specific data included: (1) hospital characteristics (i.e. established time, number of beds, hospital type, regions/localities) and (2) status of social media usage on two of the most popular local social media platforms in China (i.e. initiated time, number of followers and number of tweets or posts). We further used a logistic regression model to test the association between hospital characteristics and social media adoption. Results: A total of 537 (76.17%) tertiary-referral hospitals have created official accounts on either Sina Weibo or WeChat. Of these, WeChat is more popular than Sina Weibo. In addition, our study suggests that larger and newer hospitals with greater resources are more likely to adopt social media, while hospital type and affiliation to universities are not significant predictors of social media adoption among hospitals. Conclusions: Our study demonstrated that hospitals are more inclined to use WeChat. The move by hospitals from Sina Weibo to WeChat means that patients are seen to be not satisfied by mere communication and now place more value on health services delivery. For the future, a long journey still lies ahead for hospitals in running their official social media accounts.