Table 7.

Strategies for reducing negative outcomes of online consumer health information (OCHI).

Stage and subthemes		Example quote
Stage 1: consumers
	Be aware of limitations of OCHI	“You have to be careful, when you do a Google search you get a ton of stuff there and sometimes rewording your search you get different things, so you want to be reading the same thing and not doing something that could do more damage than good.” [Isabel]
	Reliable and relevant sources of OCHI	“I think there are already doctors online, but I don’t know maybe something more precise because Web MD can be precise but it’s not that precise, like you can have just normal back pain and it will direct you to kidney failure.” [Lara]
	Follow physician-provided OCHI or search parameters	“...but also, if there is a 2-week delay between getting a scan and seeing the professional about something that is serious, you should be provided with, you know, here are search parameters that you should look up that are neutral and that might give you content to reflect on so that you have an informed discussion with your doctor…” [Harry]
	Discuss OCHI with physician, telehealth, or members of social network	“I keep in mind that it’s on the internet, so if I was really stressed I would go talk to a real person. I am skeptical of the information so if I was worried I would go talk to a doctor.” [Jenny]
Stage 2: practitioners and librarians
	Provide reliable sources of OCHI	“Look it’s there, so instead of resisting it, let’s provide high quality alternatives so we have a little more control.” [Librarian #1]
	Teach people how to evaluate OCHI	“I think that if more health care providers used the approach of showing people where they look for info and pointing out potential issues with their sources and that is very effective, but it is time consuming.” [Pharmacist #2]
	Discuss OCHI during a clinical encounter	“I’ve mostly had a more positive experience just by being open and discussing it.” [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]
	Handling OCHI on alternative treatments or nonconventional therapies	“For the third vignette, we certainly don’t discourage exploration into complementary and alternative treatments, we have an excellent evidence based database we can search that have knowledge synthesis of the research that shows whether a given alternative treatment is actually effective, so we could have looked at maybe different remedies to show if there is any solid evidence and if it actually works and maybe there’s definitely bias.” [Librarian #1]