More than search? Informational and participatory eHealth behaviors Wenhong Chen a,⇑ , Kye-Hyoung Lee b a Department of Radio-Television-Film, College of Communication, University of Texas at Austin, United States b Department of Educational Administration, College of Education, University of Texas at Austin, United States article info Article history: Keywords: eHealth literacy Online health information search Informational eHealth behaviors Participatory eHealth behaviors Facebook Health 2.0 abstract Few studies in the eHealth literature have paid attention to participatory eHealth behaviors. Addressing this gap, the present study examines how informational and participatory eHealth behaviors are related to eHealth literacy, Internet use and Facebook interaction, as well as user characteristics. Drawing on a sample of college students (N = 540), results from Structural Equation Modeling (SEM) analysis show that eHealth literacy has a positive direct effect on informational eHealth behaviors. It also serves as a medi- ator suppressing the negative relationship between excellent mental health status and eHealth behaviors. While both instrumental Internet use and Facebook interaction are related to participatory eHealth behaviors, only instrumental Internet use is associated with informational eHealth behaviors. There are significant eHealth disparities by health status, gender, and class. Implications for health communi- cation and promotion are discussed. Ó 2013 Elsevier Ltd. All rights reserved. 1. Introduction eHealth behaviors are multifaceted and may include using information and communication technologies to seek health infor- mation, communicate health issues, purchase medicine, or partic- ipate in online health support groups (Atkinson, Saperstein, & Pleis, 2009; Norman, 2011; Rice, 2006). A better understanding of people’s eHealth behaviors helps to advance an emerging literature on how the Internet and social media can be leveraged for health communication, promotion, and intervention (Gold et al., 2012; Luca & Suggs, 2013; Oh, Rizo, Enkin, & Jadad, 2005; Stellefson et al., 2011). Informational eHealth behaviors involve online health informa- tion search. About 72% of adult American Internet users searched health information online within the past year (Fox & Duggan, 2013). Since the mid-2000s, the rapid diffusion of social media, especially social networking sites (SNSs), has offered additional sources of health information and new venues for participatory eHealth behaviors such as using SNSs to post, share, or comment on health-related issues, join or develop online health communi- ties, or maintain healthy lifestyles. A large-scale survey shows that 32% of Americans have used SNS for health-related activities (Thackeray, Crookston, & West, 2013). Another national survey suggests that about 11% of adult American Internet users have posted about health matters and 9% have started or joined a health-related group on SNSs (Fox, 2011). Informational eHealth behaviors have been the center of an emerging literature on eHealth behaviors (Renahy, Parizot, & Chau- vin, 2010). By contrast, participatory eHealth behaviors have been less studied (Stellefson et al., 2011; van der Vaart et al., 2011). Even studies that have examined individuals’ social media use for health issues have focused on social media as a source for information rather than a new venue for participation (National Research Corporation, 2011; Thoren, Metze, Bührer, & Garten, 2013). As importantly, there has been a lack of research that integrates insights from digital divides, eHealth disparities, and eHealth literacy literatures to examine how Internet and Facebook usage patterns, eHealth literacy, health status, and uses’ socio-demo- graphic characteristics are related to eHealth behaviors. This study aims to address these critical knowledge gaps. 2. Literature review The digital divide literature has focused on how users’ socioeco- nomic status (SES) and socio-demographic characteristics shape their Internet access and use (Chen, 2013; DiMaggio, Hargittai, Neuman, & Robinson 2001; Hargittai & Hinnant, 2008). There has been a growing body of literature demonstrating eHealth behav- iors can vary by SES and socio-demographic characteristics (Cotten & Gupta, 2004; Thoren et al., 2013). Furthermore, eHealth literacy has important implications for eHealth behaviors (Lustria, Smith, & Hinnant, 2011; Norman, 2011; Stellefson et al., 2011). 2.1. Usage patterns General Internet use in terms of the year of Internet experience, the amount of time online, and the frequency of Internet activities 0747-5632/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.chb.2013.07.028 ⇑ Corresponding author. E-mail addresses: wenhong.chen@austin.utexas.edu (W. Chen), kyelee@ mail.utexas.edu (K.-H. Lee). Computers in Human Behavior 30 (2014) 103–109 Contents lists available at ScienceDirect Computers in Human Behavior journal homepage: www.elsevier.com/locate/comphumbeh