Seeking but Not Discussing Online Health Information with Physicians: Patient E-Health Literacy and Empowerment Profiles and the Role of Patient-Centered Communication (Preprint)

BACKGROUND Patients frequently search for health information online and value physician support in evaluating this information, yet many hesitate to share their findings during consultations. This hesitation can hinder collaborative information evaluation and shared decision-making. While extensive research has examined patients' information-seeking behavior, little has focused on patients' disclosure of this information to their physicians. OBJECTIVE Guided by the Health Empowerment Model and the Linguistic Model of Patient Participation in Care, this study aims to (1) identify distinct patient profiles based on their e-health literacy and psychological health empowerment levels, (2) examine how these profiles differ in online health information seeking and subsequent disclosure to physicians, and (3) investigate whether patient-centered communication (PCC) promotes patient information disclosure and whether this effect differs across patient-profile groups. METHODS This study included 2,001 Chinese participants through an online survey using convenience sampling. Patient profiles were identified using K-means cluster analysis with standardized z-scores of e-health literacy and psychological health empowerment. Differences between profiles were examined using one-way ANOVA, Chi-square tests and pairwise comparisons. Regression analyses were conducted to examine the association between patient-centered communication and patients' disclosure of internet-sourced health information. To assess whether this association differed across patient-profile groups, we conducted moderation analyses with Hayes's PROCESS macro. RESULTS Four distinct patient profiles were identified: Effective Self-Managers (high literacy, high empowerment; n=996, 49.78%), Moderate-Needs Dependent Patients (moderate literacy, low empowerment; n=408, 20.39%), High-Needs Patients (low literacy, low empowerment; n=68, 3.40%), and Dangerous Self-Managers (low literacy, high empowerment; n=529, 26.44%). Effective Self-Managers showed the highest intention to seek (M 4.01, SD .88) and disclose (M 3.43, SD 1.02) online health information, as well as the highest actual seeking rate (800/996, 80.3%) and high disclosure rate (465/800, 58.1%). Dangerous Self-Managers and Moderate-Needs Dependent Patients had similar moderate intentions and behaviors in both seeking and disclosure. High-Needs Patients demonstrated the lowest intention for seeking (M 2.13, SD 1.26) and disclosure (M 1.85, SD 1.00) and the lowest actual seeking rate (25/68, 36.8%), but the highest disclosure rate (16/25, 64.0%) among those who did seek information. Patient-centered communication was positively associated with information disclosure (OR = 1.26, 95% CI = 1.04–1.53, P = .02), with no significant differences across patient-profile groups (χ²(3) = 1.69, P = .64). CONCLUSIONS E-health literacy and psychological health empowerment can classify meaningful patient groups with distinct health information behavior patterns. Active online health information seeking and shared decision-making of online health information needs both adequate e-health literacy skills and empowerment. Physicians should adopt patient-centered communication strategies that acknowledge patients' information-seeking efforts and create supportive environments for patient sharing their online findings, ultimately improving patient–physician relationships and quality of care.