Table 4.

Factors influencing online health information seeking among individuals with diabetes, organized by the Social Ecological Model^a.

Influencing factors					Evidence basis		Direction		Reported references
Individual factors
	Sociodemographic
		Increasing age		QUANTb and QUALc		–d		[23,40,42,44,59-61,71,75,92,96]
		Greater education level		QUANT and QUAL		+e		[23,38,42,44,54,59-61,63,71,75,76,96,97,104,112]
		Higher household income		QUANT and QUAL		+		[23,60,61,71,96,100,112]
		Female sex		QUANT and QUAL		+		[40,96,104,112]
		Racial minorities		QUANT		–		[96]
		Employment		QUANT		+		[71,112]
	Health status
		Shorter duration of diabetes		QUANT		+		[43,60,61]
		Poor glycemic control		QUANT		+/–f		[60,61]
		Type 1 diabetes (vs type 2 diabetes)		QUANT		+		[60,89]
		Obesity		QUANT		+		[96]
		Reporting neuropathy		QUANT		+		[61]
		Reporting severe hypoglycemia		QUANT		+		[38]
		Better self-reported health		QUANT		–		[76]
		Receiving lifestyle modification only		QUANT		+		[71]
		Having a family history of diabetes		QUANT		+		[71]
		Newly diagnosed diabetes		QUAL		+		[53]
	Psychological
		Perceived insufficient knowledge		QUAL		+		[73,90,91,97,107]
		Negative emotions (eg, anxiety, distress, fear)		QUANT and QUAL		+/–		[72,76,80,87,90,98,108]
		Desire for greater control		QUAL		+		[53,62,91]
		Preference for physical interaction		QUAL		–		[66,91]
		Lack of confidence in using digital devices		QUAL		–		[91]
		Highly activated patients		QUANT		+		[61]
		Higher perceived threat of complications		QUANT		–		[76]
		Higher efficacy beliefs in diabetes management		QUANT		–		[76]
	Knowledge and skills
		Lower health literacy		QUANT and QUAL		–		[48,50,51,73,98]
		Lower eHealth literacy		QUANT and QUAL		–		[56,63,72,78,87,91,104]
		Inexperience in internet use		QUAL		–		[53]
		Limited digital literacy		QUANT		–		[84,100,116]
		Limited exposure to diabetes education		QUANT		–		[59]
Interpersonal factors
	Social support
		Online peer support		QUAL		+		[57,63-65,78,80,82,108]
		Family encouragement and assistance		QUAL		+		[51,56,67,80]
		Sense of community		QUAL		+		[80,82,111]
		Family as an information substitute		QUAL		–		[53,62]
	Relationships and interactions with health care professionals
		Communication barriers		QUAL		+		[57,66,91,102,107]
		Inadequate information provision		QUAL		+		[46,65,66,80,91,97]
		Higher trust		QUAL		–		[53,62,65,78,107]
		Recommendation and guidance to online sources		QUAL		+		[46,73,91]
Organizational factors
	Health care delivery and organizational structure
		Disorganized care		QUANT		+		[61]
		Information overload		QUAL		+		[102]
	Health care access and use
		More frequent clinical visits with health care professionals		QUANT		+		[23,43]
		Limited health care access		QUAL		+		[53,114]
Environmental factors
	Accessibility
			Limited access to the internet and technology	QUANT and QUAL		–		[38,56,66,90,91,114,116]
			Convenience and ease of access	QUAL		+		[80,87,91]
	Source characteristics
			Information overload	QUANT and QUAL		–		[48,53,66,67,78,79,84,87]
			Conflicting information	QUAL		–		[98,107]
			Misinformation	QUAL		–		[63,64,79,82]
			Low trust in online sources	QUAL		–		[53,55,57,62,66,91,107,117]
			High trust in peer sources	QUAL		+		[63,80]
			Perceived usefulness of internet	QUANT and QUAL		+		[46,50,67]
			High complexity of information (eg, medical jargon and technical language)	QUAL		–		[48,66,67,74]
			Excessive advertising	QUAL		–		[107]
			Inappropriate content depth	QUAL		–		[107]
			Infrequent updates	QUAL		–		[107]
			Language availability of source	QUAL		+		[72,73]
			Accessible content presentation and layout	QUAL		+		[55,64,78,111]

^aOf the 81 included studies, 54 reported extractable data relevant to this outcome.

^bQUANT: quantitative findings.

^cQUAL: qualitative findings.

^dThe “–” sign indicates a negative effect (indicating a negative association or hindrance of online health information seeking).

^eThe “+” sign indicates a positive effect (indicating a positive association or facilitation of online health information seeking).

^fThe “+/–” indicates mixed findings (indicating both positive and negative associations, or factors described as both facilitating and hindering online health information seeking across studies).