Table 1.

Issues in an apomediation vs intermediation environment [16].

Dimension	Intermediation Environment	Disintermediation/Apomediation Environment
Overarching Issues
Environment	Managed	Autonomous
Power	Centralized; power held by intermediaries (experts, authorities)	Decentralized; empowerment of information seekers
Dependence	Information seekers dependent on intermediaries (physicians, parents); intermediaries are necessary	Information seekers are emancipated from intermediaries as apomediaries (peers, technology) provide guidance; apomediaries are optional
Nature of Information Consumption	Consumers tend to be passive receivers of information	Consumers are “prosumers” (ie,, co-producers of information)
Nature of Interaction	Traditional 1:1 interaction between intermediary and information seeker	Complex individual- and group-based interactions in a networked environment
Information Filtering	“Upstream” filtering with top-down quality assurance mechanisms	“Downstream filtering” with bottom-up quality assurance mechanisms
Learning	More formal; learning through consumption of information	More informal; learning through participation, application, and information production
Cognitive Elaboration	Lower cognitive elaboration required by information receivers	Higher elaboration required by information seekers; higher cognitive load unless assistance through intelligent tools
User	More suitable for and/or desired by preadolescents, inexperienced or less information literate consumers, or patients with acute illness	More suitable for and/or desired by older adolescents and adults, experienced or information literate consumers, or patients with chronic conditions
Credibility Issues
Expertise	Based on traditional credentials (eg, seniority, professional degrees)	Based on first-hand experience or that of peers
Bias	May promote facts over opinion, but opportunity for intermediary to introduce biases	May bestow more credibility to opinions rather than facts
Source Credibility	Based on the believability of the source’s authority; source credibility is more important than message credibility	Based on believability of apomediaries; message credibility and credibility of apomediaries are more important than source credibility
Message Credibility	Based on professional and precise language, comprehensiveness, use of citations, etc.	Based on understandable language, knowing or having experienced issues personally
Credibility Hubs	Static (experts)	Dynamic (opinion leaders)
Credibility Evaluations	Binary	Spectral