Table 5.

Negative outcomes of online consumer health information (OCHI).

Stage and subtheme		Example quote
Stage 1: consumers
	Increased worrying	“Sometimes it is anxiety inducing. If you can’t find something that’s a good match for what symptoms you’re having or if you find something that is a good match that isn’t so pleasant.” [Betty]
	Tension with family members	“One of my aunts takes online health info way too far, and everything online, she follows, it doesn’t matter where it’s from which is horrible because the internet has all sort of things...for 5 years my cousin’s life had all the random health natural remedies online, never doctors, it was so bad. It was disturbing when we found that when he would have an infection she wouldn’t take him to a doctor but make him drink honey...This situation caused stress between family members worried about the information she used.” [Vanessa]
	Postponing (not seeking help for) a health problem	“All my symptoms match a virus going around I read about it and I thought it will, blow over in a week, I don’t need to miss class to go to a doctor’s appointment and then I ended up going to the doctor and it ended up being an ear infection and a sinus infection and it turned into 2 months of being miserable...” [Ella]
Stage 2: practitioners and librarians
	Increased worrying	“Yeah, I think so, she was worried, she took time off work to come in to see me, and she waited in the waiting room for a while. So, I have to take her worry seriously. This applies to many patients I see, where there are no actually worrisome symptoms, if they had waited a few days whatever they had would have gone away on its own. But they had read something online either after Googling their symptoms or after accidentally stumbling on a piece of online information through social media for example, and they worry they might have that.” [Doctor #3]
	Spending money on nonbeneficial products	“A lot of the herbal and complementary and alternative therapy stuff, the biggest harm to a lot of people is that it costs money and might not work... BP: I think the main consequence is that they can’t afford, it’s common for people who are poor to have poor literacy so will believe all this stuff they read online or Dr. Oz, so they end up spending money that they shouldn’t be spending.” [Pharmacist #2]
	Tension in the provider-patient relationship	“I want them to know that I’m aware of it, that I’m not ignorant, because a lot of time this OCHI can undermine their trust in your ability and your competence and they will say why didn’t you tell me about this? And sometimes the reason we haven’t told is because we think that it will just scare them which is true, and we do.” [Nurse #1]
	Nonadherence to management plan	“I think one of the biggest ones, the area I’ve had most problems with is mental health, it’s a huge issue and affects a particular anxiety, a patient who is going through a lot of problems unfortunately the internet and their ability to get information is a major block to being treated. They would look up the side effects of the medications because they are more suggestible, experience every side effect of the medication and eventually stop it.” [Nurse #1]
	Postponing seeking medical help	“We had a gentleman come in here [health library] and he was looking for information, and he started discussing what was wrong with him and saying he felt numbness in his leg and I said immediately let me get you a wheelchair and transport you to the emergency room. He was asking me for info about something that I clearly couldn’t solve, and part of my job is identifying when someone comes to me and saying you should go see a doctor or go to the emergency room.” [Librarian #2]