Computers in Human Behavior 56 (2016) 289e294

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Computers in Human Behavior

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Full length article

Health information seeking in the Web 2.0 age: Trust in social media,
uncertainty reduction, and self-disclosure
Wan-Ying Lin a, *, Xinzhi Zhang b, Hayeon Song c, Kikuko Omori d
a
City University of Hong Kong, Hong Kong
b
School of Professional Education & Executive Development, The Hong Kong Polytechnic University, Hong Kong
c
University of Wisconsin-Milwaukee, United States
d
St. Cloud State University, United States

a r t i c l e i n f o a b s t r a c t

Article history: Self-disclosure is purposeful disclosure of personal information to other people, and online self-
Received 12 January 2015 disclosure on health-related issues is important in promoting a safe and sound online health environ-
Received in revised form ment. The present study investigates the ways in which youths engage in online self-disclosure of health-
24 August 2015
related issues in the Web 2.0 age. We examine how self-disclosure is driven by the level of trust in social
Accepted 28 November 2015
Available online xxx
media and uncertainty reduction actions, i.e., seeking information to verify and challenge the pre-
scription after visiting medical professionals. Comparative surveys were conducted in Hong Kong, South
Korea, and the U.S., respectively. Compared to their counterparts in South Korea and the U.S., youths in
Keywords:
Social media
Hong Kong were significantly more likely to disclose personal health issues with peers online. Hong Kong
Online self-disclosure youths also held the highest level of trust towards health-related information on social media. Mean-
Trust while, both the level of trust in social media and uncertainty reduction actions were positively associated
Uncertainty reduction with online self-disclosure.
Online health information seeking © 2015 Elsevier Ltd. All rights reserved.

1. Introduction
New media have become important channels for seeking and
sharing health-related information. Scholars believe that new
media, especially social media, have great potentials to support
information searching and decision-making on self-care and
health-related issues (Miller & Bell, 2012). A recent report suggests
that more than a third of U.S. adults would turn to the internet to
search the medical condition they or someone else might have (Fox
& Duggan, 2013). Nonetheless, the proliferation of new media in
health care also poses several problems and challenges. First, the
quality of the health-related information on social media is far from
perfect, which are often inconsistent, misleading, and not trust-
worthy (Pant et al., 2012). A few studies have indicated that peo-
ples' trust of online health information is a major factor that
influences their follow-up actions after information search, for
example, to further discuss health-related topics, or to be willing to
share health information (Hou & Shim, 2010; Metzger & Flanagin,
* Corresponding author. Department of Media and Communication, City Uni-
versity of Hong Kong, 83 Tat Chee Avenue, Hong Kong.
E-mail address: wanying@cityu.edu.hk (W.-Y. Lin).
2011; Ye, 2011; Yun & Park, 2010). Second, people are now more
likely than before to engage in online health information seeking to
verify or even challenge the prescriptions offered by medical pro-
fessionals, especially when they experience incongruence or un-
certainties about a certain prescription. Based on a national survey
of 3,014 adults living in the U.S., the Pew research report indicated
that 60% of the so-called “online diagnosers” (i.e., those who con-
sulted online media for health-related issues) living with chronic
conditions ever talked with a medical professional about the in-
formation they found online, and about one in five of this group of
people reported that the clinician offered a different opinion (Fox,
Duggan, Rainie, & Purcell, 2013).
Therefore, in order to promote a friendly online health envi-
ronment, it is important that users feel comfortable to engage and
disclose themselves in the cyberspace. Focusing on the concept of
self-disclosure, the present study seeks to examine the extent to
which trust in social media and uncertainty reduction strategies
would lead to self-disclosure. Self-disclosure is purposeful disclo-
sure of personal information to another person. Self-disclosure on
health issues is important because it is a strategy that helps con-
sumers to manage health-related information (Checton & Greene,
2015). As proposed by Frattaroli (2006), self-disclosure has health
benefits and is closely associated with physical and mental well-

http://dx.doi.org/10.1016/j.chb.2015.11.055
0747-5632/© 2015 Elsevier Ltd. All rights reserved.
290 W.-Y. Lin et al. / Computers in Human Behavior 56 (2016) 289e294
being. Hence, we ask: To what extent would people disclose their
personal health issues with others online? How do trust in online
health information sources and uncertainty reduction actions in-
fluence online self-disclosure of health-related issues?
2. Self-disclosure in the cyberspace
Self-disclosure is defined as an “act of making yourself manifest,
showing yourself so others can perceive you” (Jourard, 1971, p. 19).
It can be considered as one of the strategies for individuals to
manage the information acquired (Checton & Greene, 2015). Self-
disclosure was found to play an important role in the online
communication process. For instance, in the development of a
romantic relationship, self-disclosure helped individuals to collect
information about the communicators and to project future in-
teractions (Gibbs, Ellison, & Lai, 2011). Meanwhile, Wang, Jackson,
and Zhang (2011) found that online communication via instant
messaging was positively correlated to online self-disclosure for
adolescents. They also discovered that for boys and for those who
experienced high social anxiety, online communication via instant
messaging had a greater impact on online self-disclosure.
The proliferation of social media provides new channels for
sharing and self-disclosing health-related information (Rutsaert
et al., 2013). As noted by Checton and Greene (2015), to take care
of a chronic illness, one needs to manage information on the illness,
while sharing health information with others is a crucial part of
such information management strategies. The reason is that, as
argued by Walton and Rice (2013), self-disclosure was a reciprocal
benefit-exchanging process where, after one's disclosure, an equal
or greater disclosure from the others was expected. Other studies
found that people disclosed themselves to others because they
believed the disclosure would bring returns in terms of encour-
agement and empowerment (Zolowere et al., 2008). Self-disclosure
generates pre-commitment between the people, which in turn
encourages “a leap of faith and reciprocal self-disclosure”
(Henderson & Gilding, 2004, p. 487) and facilitates interpersonal
communication. A recent survey suggested that, of the 8% of
internet users in the U.S. who indicated that they had made health-
related posts online, nearly half of them said they were sharing
their personal health experience (Fox, 2014). For those who had
two or more chronic conditions, they were more likely to post a
health-related question or share their own personal health expe-
rience online in any way, compared to their counterparts who had
fewer chronic conditions. Hence, self-disclosure plays an important
role in the online health information seeking process.
3. Trust in social media, self-disclosure, and health outcomes
The level of trust in communication channels and institutions
has been found to be an important predictor of self-disclosure, as
trust reduces perceived risks and costs associated with disclosing
private or sensitive information (Chen & Sharma, 2013). For
example, a secondary data analysis of the 2009 Pew survey in the
U.S. revealed that the level of trust in individuals and institutions
was associated with the level of trust in the internet, whereas trust
of the internet positively predicted one's disclosure of identifiable
information online (Mesch, 2012). Similar findings were shown in
Dutch internet users, where trust in government organizations
strongly influenced individuals' disclosure of personal data among
the users (Beldad, van der Geest, de Jong, & Steehouder, 2012).
In a similar vein, scholars discovered that self-disclosure of
health-related issues was promoted by trust, a feeling of safety, and
an obligation to others (Zolowere et al., 2008). Paiva and colleagues
(2011) found that self-disclosure on sensitive health issues, i.e., the
HIV-related issue, required a high level of mutual trust, and the
disclosure happened more frequently among close partners and
those who were also HIV-positive (Paiva, Segurado, & Ventura
Filipe, 2011). A study carried out in rural China suggested that
trust was rated as the first reason for people to disclose sensitive
issues, followed by a feeling of needing help, and a feeling of close
friendship (Ding, Li, & Ji, 2011). Using the data from the 2007 Health
Information National Trends Survey, Hou (2010) found that trust in
online health information was a significant predictor of conducting
health-related activities via the internet. Similarly, Huh, DeLorme,
and Reid (2005) discovered that the higher level of trust in online
drug-related information, the more likely one would engage in
three types of behaviors, including communicating doctors, talking
with others, and seeking more health-related information. Addi-
tionally, Chen and Sharma (2013) drew upon the social capital
theory and concluded that the level of trust in other users on social
networking sites was positively associated with the degree of self-
disclosure. Hence, based on the above discussion, we propose that:
H1: Trust in social media is positively associated with self-
disclosure online.
4. Uncertainty reduction and self-disclosure
As stated earlier, the trend of consumer-centered health services
would lead to an increasing number of health-related consumers
via new media (Yun & Park, 2010). For example, nearly one-third of
internet users reported that they had consulted online reviews or
rankings of health care services or treatments (The Internet and
Health, 2012). When there is a lack of sufficient information from
traditional medical professionals, uncertainties arise and online
media provide individuals with an opportunity for further infor-
mation seeking and sharing so as to evaluate, verify, or even chal-
lenge the prescriptions (Fox et al., 2013).
Theoretically, cross-checking health information through both
online and offline channels is similar to the “online disinhibition
effect” (Suler, 2004). The disinhibition effect states that people
would “say and do things in cyberspace that they would not ordi-
narily say and do in the face-to-face world. They loosen up, feel less
restrained, and express themselves more openly” (Suler, 2004).
Uncertainties lead to communication practices such as information-
seeking behaviors, while people tend to observe and check other
people's behaviors by participating in a number of strategies to seek
more information about others (Berger, 1979). In other words, un-
certainty reduction actions are likely to generate self-disclosure. As
researchers discovered in studying the online dating process, “on-
line daters may be more likely to seek confirmatory information
about potential partners early in the process, as a basis for cali-
brating their own self-disclosure” (Gibbs et al., 2011). Similarly,
Courtois and colleagues (2012) found that both passive uncertainty
reduction strategies (i.e., passively looking at acquaintances' online
profile to get more information) and active uncertainty reduction
strategies (i.e., actively communicating with the acquaintances)
were positively associated with the degree of self-disclosure to the
acquaintances (Courtois, All, & Vanwynsberghe, 2012). Meanwhile,
their studies found that uncertainty reduction actions positively
mediated the effect of social anxiety on the level of certainty about
the respondents' friends (Courtois et al., 2012). Gibbs and col-
leagues (2011) also found that the frequency of taking uncertainty
reduction actions were affected by concerns of online dating, such
as security and privacy, whereas uncertainty reduction actions were
positively linked to self-disclosure (Gibbs et al., 2011).
Informed by the above empirical findings, we argue that, if an
individual experiences uncertainties after visiting a doctor, he/she
is more likely to open up him/herself to discuss personal health-
related issues. As mentioned earlier, self-disclosure is a benefit-
driven activity. If one has experienced inconsistencies with the
 W.-Y. Lin et al. / Computers in Human Behavior 56 (2016) 289e294
medical services, i.e., having high frequency of alternative infor-
mation seeking behaviors, one will be more likely to disclose
oneself in the cyberspace in order to gain or exchange for more
health-related information to reduce the uncertainty. Hence, we
propose that:
H2: Uncertainty reduction actions are positively associated with
self-disclosure online.
5. Research contexts
Three societies are chosen for this study, i.e., Hong Kong, South
Korea, and the U.S., where internet penetration rates are among the
highest in the world, and an East-West comparison is possible.
Statistics show that people's online health information seeking
behaviors are different in these societies. For example, 59% of the
U.S. internet users reported that they ever looked online for health
information in the past year (Fox & Duggan, 2013). In Hong Kong,
barely a third of a representative sample responded that they had
sought health information via the internet, while the figure was far
lower than conventional media such as print media (66.2%) and
television (61.4%) (Wang, Viswanath, Lam, Wang, & Chan, 2013). In
South Korea, while people are actively seeking health information
in general, studies suggest that “health-related information and
services have a lower profile than other services due to a perceived
lack of librarian expertise in searching and evaluating health re-
sources” (Oh, Lauckner, Boehmer, Fewins-Bliss, & Li, 2013, p. 2072).
Despite of the discrepancies, several recent reports clearly point
out that the type of peer-to-peer healthcare has become a trend.
Particularly, in the U.S., the Pew research report showed that,
among online health information seekers, 16% in the past year tried
to find others who might share similar health concerns. Over one
quarter of internet users had read or watched someone else's
experience about health or medical issues in the past year (The
Internet and Health, 2012). While comparative statistics in South
Korea and Hong Kong are fairly limited, we propose a research
question to address the cross-society differences in the health-
related communication practices:
RQ1: What is the relationship between trust, uncertainty
reduction actions, and self-disclosure across three societies?
6. Data and method
6.1. Survey instruments and participants
The survey questionnaires were developed in English first and
then translated into Korean and Chinese. The back translation
method ensured the standardization of questions. Surveys were then
administered among college students living in the metropolitan areas
in three different regions: the United States, South Korea, and Hong
Kong in 2012. Participants were solicited from large lectures in each
selected university using a standardized recruitment strategy and a
data collection method. Participation was voluntary (n ¼ 789).
6.2. Measurements
6.2.1. Dependent variable
6.2.1.1. Online self-disclosure. Online self-disclosure was modified
from the Self-Disclosure Amount subscale of the Revised Self
Disclosure Scale (Wheeless & Grotz, 1976). It was measured by
three items, each with a 7-point Likert-type scales (7 ¼ always;
1 ¼ never). The items read: “I do not discuss my health issues with
others online” (reversely coded in later analysis), “I share my per-
sonal health information on the internet,” and “I offer my health
experiences on the Internet to help others” (M ¼ 2.59, SD ¼ 1.20,
Cronbach's Alpha ¼ .71).
291
6.2.2. Predictor variables
6.2.2.1. Trust in social media. The measurement of the trust of
social media-based health information sources followed previous
studies on how individuals evaluated the trustworthiness of
health information online (Richardson et al., 2012). It included
how much trust one had on blogs, BBS, and social networking
sites, with each measured by a seven-point scale ranging from
“very trustful” to “not trustful at all” (M ¼ 3.34, SD ¼ 1.13, Cron-
bach's Alpha ¼ .82).
6.2.2.2. Uncertainty reduction actions. To measure uncertainty
reduction strategies, we adopted the findings by Brashers et al.
(2000) that how individuals coped with uncertainties in health
information seeking. We constructed an index of five information-
seeking or information-appraisal strategies that online health in-
formation seekers might use to verify or challenge the diagnosis or
prescription after visiting the medical professionals. The re-
spondents were asked a set of five questions ranging from
1 ¼ never, and 7 ¼ always below a leading question: “when would
you use the internet,” followed by “after seeing my doctor to vali-
date consultation,” “to find different options for treatment,” “to find
alternative health options that may be less invasive than what they
do,” “to see if my prescribed medicine has any side effects that were
not discussed at,” and “to seek alternative treatment or medicinal
information (e.g., herbal medicine).” They were therefore averaged
to form an index that represented the amount of disagreement
experienced after visiting the professional medical services
(Cronbach's Alpha ¼ .91). We also performed a factor analysis for
the items. The factor analysis indicated that all the items were
loaded on one single factor (Eigenvalue ¼ 3.73, variance
explained ¼ 74.52%, Х2 ¼ 2292.33, df ¼ 10, p < .001). These tests
suggest that the scale is reliable and robust. The scale has a mean
score of 3.16 (SD ¼ 1.40).
6.2.3. Control variables
We also included age, gender, and perceived general health
condition, as control variables. The reason was that previous
studies suggested that these individual characteristics would lead
to self-disclosure as well (Dindia, 1992; Gard, 1990; Papini et al.,
1990). By including these variables, we limited the possibility that
the relationships among our focal predictors and the dependent
variable would be spurious.
7. Results
7.1. Descriptive statistics
A total of 789 participants (289 participants from the U.S., 172
participants from South Korea, and 328 participants from Hong
Kong) were collected for the study. Among 789 participants, 39.29%
were female. For the U.S. participants, 43.60% were female. For the
South Korean sample, 59.88% were female. For the Hong Kong
participants, 24.70% were female. Overall the participants' age
ranged from 17 to 33, with an average of 20.80 and a standard
deviation of 2.21. Comparatively, participants from Hong Kong were
slightly younger (M ¼ 20.10, SD ¼ 1.67) than those in the other two
societies (the U.S.: M ¼ 20.91, SD ¼ 2.50; South Korea: M ¼ 21.96,
SD ¼ 2.10).
In the U.S. sample, the majority of participants (83.39%) were
Caucasians, followed by African Americans (5.88%), Asians (3.81%),
and Hispanics/Latinos (2.42%). For Hong Kong and South Korea,
local residents were nearly 100%. When asked about their health
conditions, American participants were the least to report healthy
(M ¼ 2.19, SD ¼ .89), followed by South Korea (M ¼ 2.84, SD ¼ 1.08),
and Hong Kong (M ¼ 3.04, SD ¼ .99), where the answer option 1
292 W.-Y. Lin et al. / Computers in Human Behavior 56 (2016) 289e294

indicated a poor health condition and the answer option 5 indi-
cated an excellent condition.
In terms of internet access through smartphones, the majority of
participants from South Korea (99.43%) and Hong Kong (95.25%)
reported that they had smartphones with internet connections, but
only 58.90% of the U.S. samples reported so. Among the samples, a
large proportion of them (86.74%) reported that they had ever
searched health information online whereas the rest did not.
Particularly, 90.31% of the U.S. samples reported that they had ever
searched health information online, whereas the percentage was
93.26% for the South Korean participants and 80.00% for the Hong
Kong participants.
The descriptive statistics of all variables for three sub-samples
are presented in Table 1.
7.2. Hypothesis testing
H1 predicts that the level of trust of health information sources
on social media, i.e., BBS, blogs, social media, is positively associated
with self-disclosure via online channels. The results from the OLS
regression analysis predicting online self-disclosure are summa-
rized in Table 2. Model 1 presents the regression analysis in all three
societies, whereas Models 2 to 4 present results from the U.S., the
South Korea, and the Hong Kong sub-sample, respectively. Models
1 to 3 reveal that the trust in social media was positively associated
with self-disclosure online. H1 is supported. Specifically, a positive
link between trust in social media and self-disclosure was found in
the U.S. and the South Korean sub-samples, but not in the Hong
Kong sample.
H2 stated that the frequency of uncertainty reduction actions
after visiting the medical professionals is positively related to on-
line self-disclosure. The results support H2 in all the sub-samples.
Regarding our research question that addresses the cross-
society comparison, there are significant societal differences on
the level of health-related self-disclosure online. Compared to their
counterparts in Korea and the U.S., youths in Hong Kong were
significantly more likely to disclose personal health issues with
peers online (F (2,684) ¼ 31.21, p < .05). Particularly, the average
level of online self-disclosure for the Hong Kong participants was
3.02 (SD ¼ 1.16), followed by South Korean (M ¼ 2.45, SD ¼ 1.08)
and American respondents (M ¼ 2.24, SD ¼ 1.18). Meanwhile, trust
in social media also varied across the three societies significantly (F
(2,696) ¼ 74.13, p < .001), where Hong Kong youths held the
highest level of trust towards the health information on social
media (M ¼ 3.82, SD ¼ .88), followed by Korean (M ¼ 3.47, SD ¼ .88)
and the U.S. respondents (M ¼ 2.75, SD ¼ 1.23). In terms of the
uncertainty reduction actions, however, there was no significant
cultural difference (F (2,678) ¼ 1.12, n.s.). The Hong Kong partici-
pants rated an average score of 3.23 (SD ¼ 1.37) in terms of un-
certainty reduction actions, followed by the U.S. participants
(M ¼ 3.18, SD ¼ 1.47) and South Korean participants (M ¼ 3.02,
SD ¼ 1.32).
8. Discussion and conclusions
Our major findings and contributions are three-fold. First, the
study demonstrates that, even in the era of “Health 2.0,” when most
people are switching to online sources for information, the

Table 1
The Descriptive Statistics of Key Variables in Three Societies (Mean with standard deviation in the parentheses).

Overall sample The U.S. Sub-Sample The S. Korea sub-sample The Hong Kong sub-sample
(n ¼ 789) (n ¼ 289) (n ¼ 172) (n ¼ 328)

M S.D. M S.D. M S.D. M S.D.

Female (%) 39.29% 43.60% 59.88% 24.70%

Age 20.80 2.21 20.91 2.50 21.96 2.10 20.10 1.67
Perceived health condition 2.69 1.05 2.19 .89 2.84 1.08 3.04 .99
Online Self-disclosure 2.59 1.20 2.24 1.18 2.45 1.08 3.02 1.16
Trust in social media 3.34 1.13 2.75 1.23 3.47 .88 3.82 .88
Uncertainty Reduction 3.16 1.40 3.18 1.47 3.02 1.32 3.23 1.37

Note: M. for Mean, S.D. for Standard Deviation.

Table 2
Standardized OLS regression coefficients predicting online self-disclosure in three societies.

Model 1 Model 2 Model 3 Model 4

Overall sample The U.S. Sub-Sample The S. Korea sub-sample The Hong Kong sub-sample

Female .044 .073 .069 .030

(.091) (.14) (.18) (.17)
Age .071 .016 .17* .10
(.021) (.029) (.043) (.044)
Perceived health condition .034 .049 .20** .0093
(.044) (.076) (.077) (.076)
Trust in social media .18*** .24*** .17* .092
(.045) (.063) (.11) (.083)
Uncertainty Reduction Actions .27*** .34*** .21* .27***
(.033) (.050) (.068) (.056)
U.S. (versus Hong Kong) .25*** e e e
(.12)
S. Korea (versus Hong Kong) .11** e e e
(.12)
Observations 634 234 151 249
Adjusted R2 .228 .242 .149 .082
R2 .237 .258 .177 .101
F Value F (7, 626) ¼ 27.76*** F (5, 228) ¼ 15.84*** F (5, 145) ¼ 6.25*** F (5, 243) ¼ 5.43***

Standardized beta coefficients; Standard errors in parentheses; *p < .05, **

p < .01, ***
p < .001.
 W.-Y. Lin et al. / Computers in Human Behavior 56 (2016) 289e294
dynamics with professional medical services still plays an impor-
tant role in facilitating one's self-disclosure of health concerns.
While previous research reveals that both online and offline health
information seekers would rely on traditional health care pro-
fessionals (Cotten & Gupta, 2004), our study shows that real-world
uncertainties would be offset by online self-disclosure and infor-
mation seeking. Our study also provides a clearer picture of the
dynamics between the offline professionals and online health-
related communication practices.
Second, while it is generally believed that the information
provided on social media by peers, rather than by medical experts,
might be misleading and less trustworthy (Pant et al., 2012), our
study suggests that trust in social media-based information is a
significant predictor of further health-related behavioral engage-
ment. Earlier studies found that peer-to-peer videos were more
effective in influencing peoples' attitudes and issue importance
(Paek, Hove, Jeong, & Kim, 2011). In other words, information
circulated among peers on social media generated larger cognitive
effects. The reason is that “perceived similarity seems to be a more
influential attribute than perceived expertise” (Paek et al., 2011).
Even though we did not ask the respondents whom they shared
information with for validation, findings from our study highlight
the relationship between the evaluation of information and infor-
mation seeking behaviors in the Web 2.0 environment.
Third, from a comparative perspective, our study found that,
while it is popular for the U.S. internet users to check out others'
experiences about health-related issues (The Internet and Health,
2012), our respondents from two digital societies in Asia, i.e.,
Hong Kong and South Korea, ranked higher than those from the U.S.
in the level of online self-disclosure. The finding is perplexing as
Americans are generally believed to favor direct communication
and tend to disclose more in the face-to-face interaction (Kim,
1994), whereas Confucian Asians prefer to keep things to them-
selves. The online disinhibition effect may offer an explanation. In
other words, people may say or do things in the cyberspace that
they would not ordinarily say or do in the face-to-face world (Suler,
2004). Previous research has suggested that computer-mediated
communication, such as the internet, provides an alternative
forum and opens up opportunities for users to express themselves
that may be otherwise discouraged in the real world (Lin, Cheong,
Kim, & Jung, 2010). Nevertheless, future studies may consider to
investigate the extent to which cultural or structural contexts may
affect the relationship between the evaluation of online informa-
tion and one's self-disclosure, online and offline.
Limitations exist. Firstly, while the present study focuses on the
extent to which one discloses him/herself, it will be intriguing for
future studies to examine what has been disclosed through the
online platform. For example, Jamison-Powell et al. (2012) con-
ducted a content analysis of Twitter messages on one particular
type of health-related issue, i.e., insomnia, and found that Tweets
with the word “insomnia” contained more negative health infor-
mation than a random sample of Tweets. Meanwhile, Attrill and
Jalil (2011) raised the concerns on the quality of self-disclosure.
They found that CMC-based self-disclosure was merely superficial
information, rather than information containing intimacy and
personal details. Hence, a closer look into the contents of self-
disclosure would provide a better understanding of such benefit
exchanging activities. Secondly, admittedly the explanatory power
of the predictors in this study is moderate; it could be that other
factors play a role in influencing one's decision to disclose him/
herself online. Scholars may consider to investigate the effect of
other factors, especially psychological predispositions, in the pro-
cess. For example, a lower concern for privacy may suggest more
self-disclosure online (Taddei & Contena, 2013). Thirdly, while our
study focused on university students, who are among the most
293
active internet users, this sample selection limits the generaliz-
ability of our results. Future research may consider to study health
information seeking behaviors by other populations, such as the
elderly or high-risk groups (Flynn, Smith, & Freese, 2006; Miller &
Bell, 2012). Lastly, the relationship between online self-disclosure
and offline self-disclosure warrants more investigation in future
studies. For instance, Skinner and colleagues (2006) found no dif-
ferences in the style of self-disclosure between online support
groups and face-to-face therapy users (Skinner & Latchford, 2006).
However, Valkenburg and associates (2011) suggested that self-
disclosure online was used to rehearse offline self-disclosure
skills (Valkenburg, Sumter, & Peter, 2011). More sophisticated
research is needed before a conclusion can be drawn. Despite of the
above limitations, our findings are important in advancing a better
understanding of the relationship between trust in different sour-
ces of information, experiences with institutional professionals,
and health-related behavioral outcomes.
Author notes
Wan-Ying Lin (Ph.D., University of Southern California) is an
Associate Professor at the Department of Media and Communica-
tion, City University of Hong Kong. Xinzhi Zhang (Ph.D., City Uni-
versity of Hong Kong) is a Lecturer at the School of Professional
Education and Executive Development at the Hong Kong Poly-
technic University. Hayeon Song (Ph.D., University of Southern
California) is an Associate Professor at the Department of
Communication, University of WisconsineMilwaukee. Kikuko
Omori (Ph.D., University of WisconsineMilwaukee) is an Assistant
Professor at the Department of Communication Studies, St. Cloud
State University.
Disclosure
This manuscript and all the authors have no conflict with any
manufacturer of a product discussed in the manuscript to disclose.
Acknowledgment
Part of this work was supported by City University of Hong Kong
under the Grant no. 9610224.
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