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Consumers' Perceptions of Online Health Information Credibility

Permanent Link: http://ufdc.ufl.edu/UFE0042157/00001

Material Information

Title: Consumers' Perceptions of Online Health Information Credibility An Examination of Site Sponsors and Interactive Features
Physical Description: 1 online resource (78 p.)
Language: english
Creator: Lee, Chia-Lun
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2010

Subjects

Subjects / Keywords: credibility, health, interactivity, source, web
Journalism and Communications -- Dissertations, Academic -- UF
Genre: Mass Communication thesis, M.A.M.C.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The credibility of online health information has become of significant concern to health communication professionals and consumers. Grounded on a proposed concept that considers both source and Web site interactivity cues applied by consumers to evaluating information and forming attitudes, this study provided empirical results about the differences in perceived credibility across different genres of Web sites. From a theoretical standpoint, this study provides an additional explanation of how these two factors influence information processing and attitude formation. Furthermore, this represents the most important contribution toward our understanding of interactivity?s effects in previous interactivity study. Meanwhile, results shows that increase the interactive features on the Web page may be a good way to increase organizations? positive image in the online environment. It is important implications for health communication practitioners who try to create positive images online.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Chia-Lun Lee.
Thesis: Thesis (M.A.M.C.)--University of Florida, 2010.
Local: Adviser: Lee, Moon.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2012-08-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2010
System ID: UFE0042157:00001

Permanent Link: http://ufdc.ufl.edu/UFE0042157/00001

Material Information

Title: Consumers' Perceptions of Online Health Information Credibility An Examination of Site Sponsors and Interactive Features
Physical Description: 1 online resource (78 p.)
Language: english
Creator: Lee, Chia-Lun
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2010

Subjects

Subjects / Keywords: credibility, health, interactivity, source, web
Journalism and Communications -- Dissertations, Academic -- UF
Genre: Mass Communication thesis, M.A.M.C.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The credibility of online health information has become of significant concern to health communication professionals and consumers. Grounded on a proposed concept that considers both source and Web site interactivity cues applied by consumers to evaluating information and forming attitudes, this study provided empirical results about the differences in perceived credibility across different genres of Web sites. From a theoretical standpoint, this study provides an additional explanation of how these two factors influence information processing and attitude formation. Furthermore, this represents the most important contribution toward our understanding of interactivity?s effects in previous interactivity study. Meanwhile, results shows that increase the interactive features on the Web page may be a good way to increase organizations? positive image in the online environment. It is important implications for health communication practitioners who try to create positive images online.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Chia-Lun Lee.
Thesis: Thesis (M.A.M.C.)--University of Florida, 2010.
Local: Adviser: Lee, Moon.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2012-08-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2010
System ID: UFE0042157:00001


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1 EXAMINATION OF SITE SPONSORS AND INTERACTIVE FEATURES BY CHIALUN LEE A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FUL FILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN MASS COMMUNICATION UNIVERSITY OF FLORIDA 2010

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2 2010 Chia Lun Lee

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3 To my family

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4 ACKNOWLEDGMENTS The completion of this study could not have been realized without the help of m any people. First and foremost, I would like to thank my chair, Dr. Moon J, Lee. Dr. Lee provided endless patience with my many questions and always gave me the affirmation I needed on the days I felt like this study was useless. She always led me to have a higher vision and supported me to make the impossible the possible. I will always keep in mind every positive impact you have made on my work. I also would like to thank my committee members, Dr. Juan Carlos Molleda, and Dr. Belio A. Martinez. They offer ed me priceless suggestions, which greatly improved the quality of my thesis. In addition, I would like to thank Yen Shen Tasi for creating a professional and artistic health Web site in this study. Without his great help, I could not have accomplished thi s thesis. Furthermore, Ying Wang and Daniel Tien helped me send out the questionnaire link. In particular, I give thanks to my senior alumna, Wen Hsin Cheng, for her warm assistance and Special thanks go to my parents who have always been there for me in good times or bad times. Both of them have always supported my academic career through words of encouragement and monetary donations. Without them, this degree would not have been possible. Finally, I want give my amazing friends in Taiwan and Gainesville many thanks. Their friendship and endless care make this journey more enjoyable and memorable. I also would like to thank Jody Hedge for making me feel great warms. I will never forget the warmhearted kindness that she hav e shown me. Most of all, I want to express my deepest gratitude to Wei Chih Peng, for his support to my personal life, his encouragement to my studies, and his sharing of frustration and happiness with me.

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5 TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................ ................................ ................................ .. 4 LIST OF TABLES ................................ ................................ ................................ ............. 7 LIST OF FIGURES ................................ ................................ ................................ ........... 8 ABSTRACT ................................ ................................ ................................ ..................... 9 INTRODUCTION ................................ ................................ ................................ ........... 11 LITERATURE REVIEW ................................ ................................ ................................ 14 Health Information and the Internet ................................ ................................ ............. 14 Credibility ................................ ................................ ................................ ................ 16 Source Credibility ................................ ................................ ............................... 16 Medium Credibility ................................ ................................ ............................. 19 Interactivity ................................ ................................ ................................ .............. 22 Interactivity and Health Communication ................................ ................................ ...... 25 Research Questions and Hypotheses ................................ ................................ ............ 27 METHODOLODY ................................ ................................ ................................ .......... 31 Experimental Design ................................ ................................ ................................ 31 Stimulus Materials and Independent Variables ................................ ............................. 31 Pretest ................................ ................................ ................................ ...................... 33 Pretest Sample and Instruments ................................ ................................ ................... 33 Pretest Result ................................ ................................ ................................ ............ 33 Main Study ................................ ................................ ................................ ............... 34 Sample and Procedure ................................ ................................ ................................ 34 Independent Variable ................................ ................................ ................................ 35 Web Site Interactivity ................................ ................................ .......................... 35 Source Cues ................................ ................................ ................................ ....... 36 Dependent Variable ................................ ................................ ................................ ... 36 Perceived Credibility ................................ ................................ ........................... 36 Attitude Toward the Web Site ................................ ................................ .............. 36 Web Site Evaluation ................................ ................................ ............................ 3 7 RESULT ................................ ................................ ................................ ......................... 39 Analysis Summary ................................ ................................ ................................ .... 39 Profile of Participants ................................ ................................ ................................ 39 Manipulation Check ................................ ................................ ................................ .. 40 Reliability Checks ................................ ................................ ................................ ..... 41

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6 Sample Analysis ................................ ................................ ................................ ........ 41 Research Questions and Hypothesis Tes ting ................................ ................................ 42 Effect of Source Cue and Interactivity on Perceived Credibility ............................... 42 Effect of Source Cue and Interactivity on User Attitudes ................................ ......... 43 Effect of Interactivity on Web Site Evaluation ................................ ....................... 43 Additio nal Finding ................................ ................................ ................................ .... 44 DISCUSSION AND CONCLUSION ................................ ................................ ................ 49 Summary ................................ ................................ ................................ .................. 49 Overview of Hypothesis ................................ ................................ ............................. 50 Conclusion and Implication ................................ ................................ ........................ 53 Limitations and Future Research ................................ ................................ ................. 55 HEALTH INFORMATION POST ON WEB SITE: DEPRSSION ................................ ........ 63 INSTRUCTIONS TO SUBJECTS ................................ ................................ ..................... 65 QUESTIONNAIRE FOR PRETEST ................................ ................................ .................. 66 QUESTIONNAIRE FOR EXPERIMENT GROUP ................................ ............................. 67 LIST OF REFERENCE ................................ ................................ ................................ .... 70 BIOGRAPHICAL SKETCH ................................ ................................ ............................. 78

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7 LIST OF TABLES Table page 3 1 Result of T test: perceived the leve l of interactivity. ................................ ......................... 38 4 1 Random assignment of participants in each condition. ................................ ..................... 45 4 2 Result of T test: perceived the level of interactivity. ................................ ......................... 45 4 3 Valid sample in four conditions. ................................ ................................ ........................ 45 4 4 Cross tabulation of four conditions and academic classification ................................ ....... 45 4 5 Reliability Check ................................ ................................ ................................ ............... 45 4 6 General usage of Internet ................................ ................................ ................................ ... 46 4 7 R esult of T test: source cue information credibility. ................................ ........................ 46 4 8 Result of T test: Interactivity information credibility ................................ ....................... 46 4 9 Resu lt of T test: source cue attitude ................................ ................................ .................. 47 4 10 Result of T test: Interactivity attitude ................................ ................................ ................ 47 4 1 1 Effects of Source & Interactivity on Perceived Usability ................................ .................. 47 4 1 2 Effects of Source & Interactivity on general attitude toward Web site ............................. 47 4 1 3 Result of T test: Inte ractivity usability ................................ ................................ .............. 47 4 1 4 Result of T test: Interactivity general attitude ................................ ................................ ... 47 4 1 5 Regression analysis of consumer attitude to ward the Web site ................................ ......... 48

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8 LIST OF FIGURES Figure page A 1 High interactive health Web site layout ................................ ................................ ............. 59 A 2 Limited interactive health Web site layout ................................ ................................ ........ 60 A 3 High interactive health Web site layout ................................ ................................ ............. 61 A 4 Limited interact ive health Web site layout ................................ ................................ ........ 62

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9 Abstract of T hesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Arts in Mass Comm unication INFORMATION CREDIBILITY: AN EXAMINATION OF SITE SPONSORS AND INTERACTIVE FEATURES By Chia Lun Lee August 2010 Chair: Moon, J, Lee Major: Mass Communication With the increasing number of reading and s earching online for health information, understanding how consumers assess the credibility of information is crucial from both conceptual and practical standpoints. Conceptually, Internet technologies hold great promise for improving health knowledge and b ehavior. Despite these exciting claims, we still know very little about how interactive Web technologies influence perceptions of health information may be inf luenced by the information source (Metzger et al., 2003). This research combines the concept of source credibility and interactive feature cues to better understand how consumers process information and how these factors jointly affect the perceptions of o nline health information credibility, as well as the attitude consumers have toward Web site and Web site evaluation. To test the concept idea which discuss above a 2 (high vs. low Web site interactivity) by 2 (government Web site and commercial Web site sources) factorial experimental design was employed. A total of 136 university students participated in the study. The results of the study indicated several important findings. First, there is a statistically significant positive correlation

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10 between sour ce cue, interactivity, and perceived information credibility. However, only source cue has a positive effect on perceived information credibility. Respondents considered the source of health information provided from a government Website was deemed signifi cantly more credible than a commercial Website. This finding suggests that online users are concerned with that both source and interactivity effect consumer's a ttitude toward Health Websites. Furthermore, interactivity has a more significant influence on consumer's attitude toward Health Web sites than source cue. Additionally, increased interactivity could lead to more positive evaluations of the Website. In co nclusion, the more interactive features such as Website and the evaluation.

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11 CHAPTER 1 INTRODUCTION The purpose of this research is to determine how the interactivi ty of health related Web sites and the source of health related information affect perceptions of credibility regarding online health information. The advancement of Web based technology has brought new and revolutionary developments to the field of health communication. With the growing number of capabilities that health care Web sites provide, consumers can access an increasingly vast store of health information. For example, one might find doctor explanations of symptoms and diseases or spin about medica l practices from patients and pharmaceutical companies. Thus, consumers are increasingly using the Internet to retrieve health information. According to the have used the Internet to search for at least 1 of 16 major health topics and, as of January 2008, the Internet had become a leading source for hea lth information (Elkin, 2008). "The Internet plays a central role in finding health information," said Veenu Aulakh, MPH California Health Care Foundation senior program officer (CHCF, 2008). The Internet has become a popular medium as a source for health information, and more important, it has enhanced consumer participation in health issues. Consumers not only seek heal th information, but they also communicate their experiences. This has led to a dramatic expansion in the health information resources available online (Cline & Haynes, 2001; Rice & Katz, 2001; Viswanath, 2005). Using various forums, contributors divulge in formation about the side effects of medicine and state which drugs effectively manage their conditions. Some patients even share their personal prescription drug histories online. On one hand, this allows consumers to get health care and support fairly eas ily. On the other hand, it exposes consumers to misinformation fairly easily. Although misinformation on social media will almost certainly be

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12 re posted and self corrected by users (California Health Care Foundation, 2008), incorrect health information is still very difficult to prevent. Once inaccurate information is published on the Internet, it might keep ill people who rely on it from seeking proper care. Thus, the credibility of online health information has become of significant concern to health com munication professionals and consumers; one study showed that approximately 86% of online health information users care about accuracy of information on the Internet (Pew American Life Project, 2000). With such high concern about finding credible health in formation, people running online health Web sites must know how to maximize the credibility perceived by their audience. related Web sites. Many studies have examined the rol e of various elements in predicting perceptions of Web site credibility, such as structural features of Web sites and characteristics of messages (Burkell, 2004; Flanagin & Metzger, 2000; Fogg, 2003; Fogg et al., 2001; Hong, 2006; Nettleton et al., 2004). However, few have looked into interactivity a defining trait of the World Wide Web (Street & Rimal, 1997). Conceptually, Internet technologies hold much promise for improving health knowledge and behavior. Despite these exciting claims, we still know very little about how interactive Web technologies influence perceptions of online health information credibility. Evidence of interactive features in health communication has been provided. Therefore, when interactive features are packaged in a form of heal th information and disseminated via the Internet, the audience may easily consume and adopt the information. Such interactive features may also influence the persuasiveness of health messages and consumer attitudes toward a Web site. However, discussions o from Web pages are rather scarce. This research addresses how interactivity affects perceptions of credibility regarding online health information. Along with the possible influence of

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13 interactivity, traditional investigations into credibility have also observed that the source within think accurate and trustworthy (Hovland, Janis, & Keelly, 1953). Indeed, a growing number of researchers have found that variations in the sources of online health information shape an compared to research on sources, the i mpact of interactivity on perceptions of credibility has been probed in various investigations of general computer mediated communication (e.g., Burgoon, Bengtsson, Cederberg, Lundeberg, & Allspach, 2000), yet few researchers have applied analyses within a n online health information setting. With the increasing number of people who are reading and searching online health information, knowing how interactivity and sources influence consumer perceptions of credibility is pivotal from both conceptual and pra ctical standpoints. As a result, the purpose of this study is to examine whether interactive features and site sponsors on a health Web site affect how people process and evaluate health information on that Web site and, in turn, how these features influen ce consumer attitudes toward online health content.

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14 CHAPTER 2 LITERATURE REVIEW Health Information and the Internet Searching for health related information has become a common activity for Internet users (Fox & Fallows, 2003). According to Meyer (1996), most health Web sites on the Internet fall into two categories: marketing services and consumer education. Survey results also indicate that more consumers are using the Internet to find and read health information than ever before. The Pew Internet and A merican Life Report (2009) found that the percentage of adults who have searched health information online has increased from 25% to 61% since 2000. The author of the st Jones, 2009 ). Indeed, numerous readers read or search among the millions pages of online health information every day (Baker and colleagues 2003; Bard 2000; Cain and colleagues 2000; Fox and colleagues 2000; Fox and Fallows 2003; Fox and Rainie 2002; Horrigan and Rainie 2002; PSRA 2002; UCLA 2003). One reason is Internet give users an open and available 24 hours a day services form answering embarrassingly personal questions to suggesting medical treatment. Another reason is the little time doctors dedicate to their patients explaining ailments and procedures. Individuals and families are turning to the internet for information lacking during doctors visits. Thus, the Internet has rapidly become a primary source for obtaining health information and advice. With the growing number of capabilities that the Web provides, the way in which consumers use the Internet to seek health information has changed. Online health related applications are as plentiful as medicine it self (Sonnenberg, 1997). ICrossing, in its 2008 report, How America Searches: Health and Wellness, found that the major online tools used to find health information are general search engines, health portals, and social media. Consumers

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15 usually access onli directly for health information, participating in support groups, Haynes, 2001). Instead of reading health information on Web sites in a passive wa y, consumers can now communicate their experiences actively. For example, 36% of consumers go online to see what others say about a medication or treatment, and 14% of consumers share their knowledge of, and experience with, a medication, treatment, or hea lth issue ( Online Health : Assessing the Risk and Opportunity of Social and One to One Media Jupiter Research 2007 ). Communication search information but also t o create information. Unlike the mass media which less involve feedback (Cassell and associates, 1998), the dynamics environment of Internet provides a valid channel for persuasive health communication. As Casell and associates (1998) state: of these resources to provide immediate, transactional feedback suggests that they can be used it realize health behavior change in a manner that is similar to interpersonal channels, while their resemblance to forms of mass media suggests an ability to d In addition, Internet based sources have the capacity to disseminate health information immediately and to reach large, geographically disparate audiences. Many health communicators have used mass media as a tool to diffuse messages, increase public awareness, and enhance information exposure (Alemi & Higley, 1995). The Internet can also be integrated with other print media and mass media channels to expand the reach of public health programs and promote program effectiveness ( Cassell, Jackson, & Cheuvront, 1998) These common features make the Internet a popular venue for health communication promotion and serve as useful tools to educate mass audiences with discerning information online. For the purpose for determining reliable online health information, the Net Foundation and Internet Healthcare Caloation have

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1 6 published to help consumers judge credibility of online information online. The Internet is an ideal medium fo r such purposes, and moreover the incorporation of Web based technologies into health communication strategies is making health related promotions more effective. Credibility The study of credibility has a long history. Much research on credibility can be divided into two overlapping classifications: studies focused on source credibility and studies examining medium credibility (Kiousis, 2001). Source credibility studies have examined how variations in communicator qualities affect the way in which people judge media messages (Austin & Dong, 1994; Hovland, Janis, & Kelley, 1953; Hovland & Weiss, 1951). Medium credibility studies have examined the channel through which the message is delivered (Kiousis, 2001; Johnson & Kaye, 1998; Newhagen & Nass, 1989; Slat er & Rouner, 1996). Because research on these two categories is not distinct (Kiousis, 2001), they both need to be discussed. Source C redibility Information source is a powerful factor affecting information credibility. One of the first researchers to exp lore credibility was Carl L. Hovland. In his book, Communication and Persuasion Hovland and colleagues (1953) described the credibility of individual sources as communicator credibility. This credibility has two major dimensions: expertise and trustworthi ness (Hovland et al., 1953; McGuire, 1969). Expertise is defined as how well informed and intelligent a communicator is about a topic (Hovland et al., 1953) and his or her tworthiness Since these findings were revealed, a variety of variables on source credibility have been examined by

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17 valence model, attractiveness is another component of source credibility. Berlo, Lemert, and Mertz (1969) cited three qualiti es that message receivers use when evaluating the source of the message: safety, qualification, and dynamism. McCroskey (1966) indicated two factors, authoritativeness and character, as constructs of source credibility based on factor analysis. Although va rious definitions of source credibility have been found in academic research, expertise and trustworthiness have been the most widely used and applied dimensions recognized by scholars (Hovland et al., 1953; Hovland & Weiss, 1951; McCracken, 1989; Ohanian, 1990). online health information environment (Dutta Berman, 2003a, 2003b), source plays a significant role in perceptions of online health information. It can be u sed as a cue to determine credibility. Eysenbach and Kohler (2002) found that consumers identify source as the chief factor when determining credibility and quality of information. In their study, while evaluating a credible health related Web site, focus group participants said they look for source first.A study also Moreover, credible sources influenc e changes in opinion regarding the direction advocated by the communicator to a greater extent than do less credible sources (Hovland & Weiss, 1951). In contrast, a message attributed than a message from a high credibility source (Hovland et al., 1951). Subsequent studies have yielded similar findings. Maddux and Rogers (1980) found that expert sources had greater acceptance of their statements than did inexpert sources. W hen audiences perceive the source as having considerable expertise and being trustworthy, they are more likely to accept or be persuaded by the message (Marquart,

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18 One of the primar y markers that advocates name for judging the quality of Internet based health information is source credibility (Tu & Hargaves, 2003; Kunst, etl., 2002; Kim, Eng &Derring, 1999). While a source that is a recognized expert, who provide information with cur rent, unbiased and no competing interests, could be judged a more reliable source. On the contrary, a source that be judged as inexpert that gave an outdated, biased and commercial interties information. Based on these standards, several characteristics ca n influence Web site expertise and trustworthiness. are the site sponsor's reputation, the ty pe of site sponsor, and the display of appropriate credentials. Rich and Belkin (1998) conducted in depth interviews with 14 faculty members and doctoral students to understand their judgments about online information. Results revealed that respondents ba sed their judgments of online information in part on two levels institutional and individual. Users in the Rich and Belkin (1998, 2000) studies looked for Web credibility markers to replace those used for traditional print media, identifying factors such a s suffixes to the URL address (i.e., .edu, .org, or .gov). Overall, nonprofit, educational, and government sources were ranked as more credible than were commercial sites (.com). (1998) respondents generally perceived .edu an d .gov sites as providing better quality information than .com sites. In term of the domain name on credibility assessment of online perceptions of credibility between gov ernment sources and commercial sources. In sum, the majority of evidence from both traditional and non traditional communication outlets suggested that source cue should influence perceived credibility.

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19 Medium C redibility In a study examining political c ampaigns on the Internet, Johnson and Kaye (1998) used an dimensions of fairness, bias, depth, accuracy, and trustworthiness. They found that politically interes ted Web users rate both online political information and information from traditional And while Johnson and Kaye found online media to be perceived as slightly more credible than newspapers, Flanagin and Metzer (2000) used a n online survey to investigate the credibility of different outlets: online information, television, magazines, and newspapers. Their findings showed that respondents viewed information seen in newspapers as more credible than information found online, on television, and in magazines. Similarly, Kiousis (2001) conducted a cross sectional survey to explore the perceived credibility of television, newspapers, and the Internet. Results revealed that newspapers are highest in credibility for news information, f ollowed by Internet news and television broadcasting. study revealed that the medium through which the message is delivered affects perceived credibility. H ow consumers evaluate the credibility of online information has been discussed for a long time. Although much evidence has revealed that the Internet has more strength and power than traditional media, several scholars have questioned whether the Internet should be trusted as much as traditional media sources. The new era of online communicatio n, Web.2.0, allows can access the Internet to contribute medical information on wikis, blogs, online forums, social networks, and message boards. For example, wiki s allow users to collaboratively contribute and update medical information onlin e. This not only collects the wisdom of the masses, but also enhances the potential to release inaccurate information. Traditional media sources employ

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20 professionals to provid e unbiased information and to assess accuracy. However, Web sites lack these professional gatekeepers who help define traditional media (Cline & Haynes, 2001). Thus, the credibility of online information may be distinguished from traditional media in consu evaluation because consumers may use different criteria according to the information presented (Newhagen & Nass, 1989). Direct observational research in a lab setting has shown that the numbers of health consumers factoring credibility of source are limited (Kohler, 2001). In fact, consumers usually judge information quality by a variety cues. According to ELM (Petty & Cacioppo, 1986), consumers judge text credibility based on either careful evaluation of arguments in the text (the make simple judgments about the merits of a given argument without attending to the argument itself (p. 3). Peripheral cues can include, for example, attractiveness of Web site the type of publication in which a text appears, and author affiliations. One study found that consumers pay more attention to surface credibility markers such as Web site design (e.g., whether it appears 001) also found that two components of Web site design decreased credibility: commercial associations (advertising) and a feeling of amateurism (broken links). First, an advertising presence or absence on a Web site can influence its credibility. Comparing different Internet domain Web sites with regard to advertising, studies show that a .org site with no advertising is the most credible, followed by a .com site featuring advertising (Walther, Wang, & Loh, 2004). Recent research has not looked at interact ive features and credibility, but has combined interactive features with other factors. Sundar, Hesser, Kalyanaraman, and Brown (1998)

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21 perceptions of political candid higher level of activity (links available about the candidates) in a site led to higher perceptions of trustworthiness (often an indicator of credibility) toward candidates. Kiousis and Dimitr ova credibility regardless of whether information came from an organiz ational site or news agency site. Instead, the interactivity and graphics helped create an impression of credibility among the users regardless of the source. Furthermore, the influence of interactivity on credibility assessment may be observed when partic ipants used interactive content (Kiousis, 2003). Freeman and Spyridakis (2004) investigated the effect of external links and publisher They found that having external links to further information is an important criterion for assessing the credibility of information on a given Web site. In other study, they examined on n ar ticle with presence (Freeman & Spyridakis, 2009, p. 162). In sum, previous studies have demonstrated that individual elements of interactive features influence credi bility assessments. With the interactive features on the Web site, it may have ty? Would the

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22 more interactive features presence on Web sites, the more credible they are? This study will discuss this possible factor. Interactivity Interactivity has been acknowledged as the leading capability that sets the Internet apart from other m edia (Ha & James, 1998; Lustria, 2007). It makes the Web a dynamic medium for two way communication, in contrast to traditional media. Also, interactivity can be useful in creating brand identity (Upshaw, 1995), facilitating online relationship marketing (Cuneo, 1995), converting consumers who are interested in becoming more interactive (Berthon, Pitt, & Watson, 1996), and exercising greater control over information seeking (Hoffman & Novak, 1996). In the past decade, scholars in mass communication have ex amined the nature of interactivity in computer mediated communication. According to Rafaeli and Sudweeks (1997), interactivity is these exchanges carry a social, bindin to which participants in a communication process can exchange roles and have control over their characteristics reflect mutual relational interactions between the message provider and the recipient. Taken it as whole, the identical characteristic of interactivity is its interpersonal communication. As Barnes (2001) states: interactivity is associated with message qualities that encourage people to respond and/ or interact with other group members. These qualities include asking questions, requesting opinions from other people, or making provocative statements. Interactivity can lead to s ociability because it (p.41). There is no generally accepted definition of interactivity and different researchers have used different conceptualizations of interactivity (Heeter, 1989). Among previous studies four tr aits of interactivity have been emphasized: the nature of the communication exchange

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23 (Burgoon, Bonito, Bengtsson, Cederberg, Lundeberg, & Allspach, 2000; Jensen, 1998; Rafaeli & Sudweeks, 1997), system or channel features (Andrisani et al., 2001; Bezjian Avery, Calder, & Iacobucci, 1998; Chou, 2003; Coyle & Thorson, 2001; Downes & McMillan, 2000; Ha & James, McMillan, 2000; McMillan & Hwang, 2002; Newhagen & Cordes, 1995; Sundar, Kalyanaraman, & Brown, 2003; Tremayne & Dunwoody, 2001), and some combination of the above (Heeter, 1989, 2000; Kiousis, 2002; Liu & Shrum, 2002; McMillan, 1999; McMillan & Huang, 2002). Many interactivity studies agree that interactivity of new c ommunication technology can be defined along three main dimensions: two way communication, active user control, and synchronicity (Heeter, 1989, 2000; Liu & Shrum, 2002). In the online instance, two way communication refers to the ability of the medium to allow reciprocal communication exchange through feedback input devices such as e mail, comment sections, or forms. Consumers can communicate with the system, with other users, or with content providers through two way communication. Active user control re fers to the ability of the medium to allow users to control the level of their information exposure and learning experience. The Internet is characterized by hyperl customize information flow and jump from one location in Synchronicity refers to the extent to which input and response are simultaneous in the process of communication (Liu & Shrum, 2002). This concept is the most ambiguous of all three because, for example, while users use the e mail function, their level of synchronicity may be low because of delayed e mail feedback.

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24 To define the interactivity of Web sites, most scholars emphasize the traits That is, several researchers have viewed interactivity as the result of elements that are present in the site (Ghose & Dou, 1998; Ha & Lincoln, 1998; Frazer & McMillan, 1999). For example, while examining the int eractivity of a Web site, the concept is usually defined as the use of hyperlinks in a site (Sundar et al., 1999). In addition, some researchers have operationalized the interactivity in terms of functional features, such as e mail links, feedback forms, c hat rooms, and audio or video downloads (Ahern & Stromer Galley, 2000; Massey & Levy, 1999). According to a Deuze (2003) study, functional interactivity means users can communicate with each other through message board systems or direct e mail links. This interactivity allows Web features to facilitate two way communication tools such as e mail links, register forms, and comment forms (McMillan, 2000a). In his later study, McMillan (2002) proposed a four part model of cyber interactivity to analyze features of health related Websites based on perceived interactivity. Tow dimension are discussed: direction and control. The features that belong to the dimension of user control include choice, search, games, curiosity devices and links. Other features such as e mail, registration, survey, order/purchase, chat, bulletin boards are fall within the dimension of direction. Moreover, researchers have asserted that multimedia content is a chief indicator regarding interactivity (e.g., Sims, 1995). Bengtsson, Burgoon, C ederber, Bonito, and Lundeberg (1999), for instance, maintained that the modality aspect of interactivity means "participants have full access to a wide array of environmental, visual, audio, and verbal context cues" (p. 3). Taken it as a whole, the prese nt study that discussed above indicate there is no standard definition of interactivity. However, most of them indicted that the interactivity on Intent are similar to interpersonal communication. User control, two way communication and

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25 synchronicity prese nce on a Web site serves as evidence of interactivity for interpersonal computer mediated environment is inherently interactive; however, varying levels of interactivity MaMillan and Hwang (2002), the higher interactive website was design to have more interactive features and more opportunities for interactive exchange and vice verse. Interactivity and Health Communication For researchers of he alth communication, interactivity is a relatively new area. With an interest in interactivity in relation to health communication, previous studies have explored interactive media technology such as CD ROMs, computer programs, touch screen programs, and In ternet sites (Rhodes, Fishbein, & Reis, 1997; Street & Rimal, 1997; Walther, Pingree, Hawkins, & Buller, 2005), which have contributed significantly to interactive health literature. There is ample research on various interactive media technologies being u sed in health communications. Meanwhile, there is increasing research interest in analyzing interactivity on health related Web sites. Various approaches have been used to explore interactivity in health communications. For example, some researchers have u sed content analysis, (e.g., Keller et al., 2002; Stout, Villegas, & Kim, 2001), while others have used an experimental design approach (e.g., Lustria, 2007). The findings of previous studies have evidenced that interactivity has a significant effect on us Meanwhile, research findings have shown that increased interactive features such as high accessibility, high user control, and personalized content can create interest in health com munication as well (Prochaska, Redding, & Evers, 1997; Schacter & Fagnano, 1999; Steuer, 1992; Stout et al., 2001; Sundar, Kalyanaraman, & Brown, 2003). Beside intrigue interesting, stems could also

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26 enhance learning because it allows learners to feely browse the materials, assessing the system based on individual mental models (Martindale, 1991; Nelson & Paulmbo, 1992; Spiro & Jheng, 1990). In addition, the qualities of interpersonal communication on an online environment make it a persuasive channel to promote healthier behaviors (Cassel Jackson & Cheuvront, 1998). In one study, scholars examined links between learning and interactivity of health related Web sites. They found that h ealth related Web sites with interactive features can deliver messages with significant effectiveness (Stout, Villegas, & Kim, 2001). Cassell and associates (1998) in their exploration of health communication on the internet found that the Internet offers a viable channel for persuasive health co both parties to bring something Also, interactive features on health care Web sites lead to higher involvement by consumers (Petty & Cacioppo, 1986). Higher in volvement by consumers can facilitate relationship building and problem solving, as well as learning of health information (Stout, 2001). One study showed that some interactive features, such as relationship building tools, could not only improve the degre e of user participation but also enhance user satisfaction, self efficacy, and memory (Thomsen, 1996; Rafaeli, 1988). For example, one in four health information seekers have joined online support groups for professional care, such as obtaining social sup port and medical information and exchanging experiences (Cyber Dialogue, 1998; King & Moreggi, 1998). Meanwhile, Lustria (2007) found that interactivity may play an important role in attracting health information seekers and in maintaining their attention Higher levels of interactivity in a health related Web site contribute to a more positive attitude toward the Web site. In one study, Wu (2005) examined the effects of interactivity on communication

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27 outcomes such as toward the Websites. And, it observed that perceived interactivity plays a mediating role in the effect of actual interactivity on attitude toward a Web site (Wu, 2005). In sum, enhance the mutual relationship and c ollaboration between the message (the organization) sender The interactive tools present in health related Web sites improve healthy behavior, clinical outcomes, and positive attitudes toward the Web sites (Murray & Bur ns, 2004, Lustria 2007). Research Questions and Hypotheses Credibility is a crucial factor affecting how consumers embrace and accept health related Web sites. Futhermore, perceived information credibility has been found to be a key determinant of persuasi on and attitude change (Chaiken & Maheswaran, 1994; Tormala et al., 2007). Therefore, it is not surprising that consumer perceptions of online information credibility have been the subject of a great deal of discussion and empirical research in CMC (Burke ll, 2004; Flanagin & Metzger, 2000; Fogg, 2003; Fogg et al., 2001; Hong, 2006; Nettleton et al.,2004). consumer attitudes, their perceptions of its credib ility, and their general evaluation of its effectiveness. The nature of a source has been shown to have an influence on consumer perceptions in an online environment. Eysenback and Khler (2002) observed that consumers identified the nature of the source as the chief factor when making determinations as to the credibility and quality of information In that study when evaluating the credibility of a health related Web site, focus group participants said they looked for the source first. Another study showe d that 42% of participants reported rejecting a health p. 6).

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28 of credibility may be influenced by the type of site sponsor (Metzger et al., 2003) In addition, both surveys of online information users and recommendations from various organizations regarding the evaluation of online information suggest that readers perceive information on a .gov Web site as being m ore credible than that on a .com Web site. Therefore, the following hypothesis is offered, based on these findings: H1: Participants viewing online health information on a .gov Web site will rate that information as being more credible than will participa nts viewing the same information on a .com Web site. In addition to source cues, prior researchers have suggested that the interactive features presence on Web site affects perceived online health information credibility. Freeman and Spyridakis (2004) inve stigated the effect of external links and publisher contact information (a that having external links to further information was an important criterion for assessing the credi bility of information on a given Web site. Also, participants rated the credibility of a Web page with a Spyridakis, 2009). A great deal of research has examined i ndividual elements of site presentation, such as navigation, interactivity, and links, in terms of credibility assessment. However, it is unclear whether the level of interactive features on Web sites plays a role in affecting information credibility. Henc e, the following hypothesis will be investigated: H2: Participants will rate health information on high interactive Web sites as being more credible than will participants viewing the same information on low interactive Web sites. In persuasion theory, so urce credibility has been recognized as having a substantial influence on communication effectiveness (MacKenzie & Lutz, 1989; McCroskey, 1966; Perloff, 2003). Past research has observed that source characteristics are antecedents to attitudes. As Burgoon

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29 Evidence has also confirmed that source credibility has a positive effect on mes sage effectiveness and consumer attitude (Hovland & Weiss, 1951; Lafferty et al., 2002; MacKenzie & Lutz, 1989). Especially, a perceived unbiased source tends to be perceived as more convincing than a biased source based on its higher credibility status ( e.g., Benoit & Kennedy, 1999). Because content from a .gov Web site should be perceived as more credible, it is expected that exposure to online health information from a .gov Web site will lead to more positive user attitudes toward a Web site. H3: Partic ipants viewing online health information from a .gov Web site will demonstrate a more positive attitude toward that Web site than those viewing the same health information on a .com Web site. Previous research has not specifically linked the interactivity literature with the small but growing body of research on audience attitude toward Web sites. However, what research there has been has found that perceived interactivity and attitude toward a Web site are highly correlated (Jee & Lee, 2002). In addition, research has also suggested that increased levels of interactivity on a Web site have a positive effect on user satisfaction; their perception of the effectiveness, efficiency, and value of a Web site; and their overall attitude toward the Web site (Thomse n, 1996; Rafaeli, 1988; Murray & Burns, 2004; Lustria 2007 ). These findings give rise to the fourth hypothesis: H4: High (versus low) interactivity will yield more favorable consumer attitudes toward a Web site. If interactivity increases the perceived cr edibility of and enhances consumer attitudes general evaluations of the Web site. Past research has found that vivid Web sites were evaluated more positively by user s (Coyle & Thorson, 2001). A Web site is the face of an organization in

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30 the online world. For health communication professors, understanding how consumers evaluate a Web site may help them to better understand how to build a relationship with their audien ces. Thus, following the Kiousis study (2006), it is argued here that two aspects of evaluation (usability and attitude toward the Web site) will be affected by interactivity: H5: Participants viewing online health information from a high interactive Web s ite will evaluate the Web site more positively in terms of usability and general attitude than those viewing a Web site with low interactivity.

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31 CHAPTER 3 METHODOLODY Experimental Design The purpose of this study was to explore how variations in site spon sors and interactivity of Web sites influenced user attitudes toward a Web site and their perceptions of its credibility. Accordingly, a 2 (site sponsors: .gov versus .com) X 2 (interactivity: high interactive Web site versus low interactive Web site) betw een subjects experimental design was employed to examine those relationships. Stimulus Materials and Independent Variables The health information participants read, obtained by permission from the Web site of the Centers for Disease Control and Prevention (CDC), covered basic information about the prevention and treatment of depression (Centers for Disease Control and Prevention, 2009)(Appendix B) However, a fictitious Web page was created by a professional Web designer to display this information. T he a rticle was presented on a generic Web site to eliminate preconceived opinions of known health Web sites. All the conditions on the Web site, such as design of the page and content, were kept constant, except for the changes to accommodate the independent v ariables, as explained below The two main independent variables for this research were the site sponsors and interactive features. A primary focus of the research concerned the owner, or source, of the Web site. That is, will the presence of an identified name on the Web site influence how consumers judge the site? To investigate this question, the headers of the dummy sites were varied to reflect the following differences in terms of site responsiveness: health.com, and health.gov. Interactivity. The Web site was especially developed for this experiment and was based on real Web sites that were reviewed before the creation of the two versions of the site used in this

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32 study. A health Web site was professionally designed in two different versions to incorpor ate high and low levels of interactivity. Following Liu & Shrum (2002), the primary dimensions of technical interactivity that were explored in this study were active user control, sensory stimulation, and two way communication. In its high interactive ver sion, the site offered users the ability to customize information flow and evinced a high potential for reciprocal communication. Participants could make use of hyperlinks and browse through the information categories indicated on several navigation bars. These features allowed participants to interact with the Web site by selecting the order of information they wanted to see at each moment. This manipulation was consistent with the definition of active control (i.e., whether consumers are able to interact with the system to choose what they want to see). Similar manipulations regarding active control have been used in other studies (e.g. Lustria, 2007; Ariely, 2000; Coyle and Thorson, 2001; Sicilia et al., 2005). In addition, the high interactive version fe atured more response mechanisms, such as a message board/chat room, a telephone number, and an e mail address. Overall, it used a nonlinear hypertext structure and included various navigation tools, hyperlinks, and a few interactive activities (e.g., inter active quizzes). In contrast, participants viewing the low interactive version had minimal navigation options and fewer information categories. The site was analogous to viewing a print advertisement in which consumers are less able to control the experie nce. Meanwhile, the only way of communicating with the Web site was via a message board, a telephone number, and an e mail address included at the bottom of the page. In agreement with MaMillan and Hwang (2002) the low interactive site was designed to have fewer interactive features and fewer opportunities for interactive exchange.

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33 Pretest The purpose of the pretest was to determine whether the participants were able to perceive a significant difference in the level of interactivity. The findings of the pr etest served as the basis for improving the study materials and streamlining the study instrument. Pretest Sample and Instruments The pretest involved 22 students at the University of Florida including undergraduate and graduate students. A survey question naire asked respondents to evaluate interactivity. First, the test subjects were randomly exposed to one of the two versions of a Web site a high or low interactive version. During that time, participants were directed to explore the Web sites and read through the stimulus articles freely. Then, they were asked to answer the pretest questionnaire, a survey questionnaire which asked respondents to evaluate of interactivity. This measure used selected items from the acti ve control and two way to signify their agreement, using ratings from 1 ( strongly disagree ) to 5 ( strongly agree ), with I felt I had a lot control over where I wanted to go on to list (Appendix C). Pretest Result The 22 respondents, 8 males (36%) and 14 females (64%), had a mean age of 23.67 years old. Of these respondents, 17 (77.7 %) were senior s and 5 (22.3%) were graduate students. To test the effectiveness of the experimental manipulation, a t test, with perceived interactivity as the dependent variable and level of technical interactivity as the independent variable, was

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34 performed. As expecte d, the high interactivity group rated their site as more interactive ( M 4.07, SD 0.26, N=11) compared to the low interactivity group ( M = 2.43, SD = 0.46, N= 11). Results of the t test (as shown in Table 3 1) showed that these differences were statistic ally significant, t=10.243, P<0.05 This analysis shows that the high interactivity site was indeed perceived to be more interactive than the low interactivity site. Main Study The main study used a 2 (site sponsors: .gov versus .com) X 2 (interactivity: h igh interactive Web site versus low interactive Web site) between subjects experimental design. Web site interactivity was manipulated in the stimulus materials by offering either a high interactive Web site or low interactive Web site. The source cue was manipulated by using different site sponsors for the Web site: .gov and .com. The experiment employed a student sample, and participants were randomly assigned to one of four treatment conditions (Table 3 2). Sample and Procedure Participants for the expe riment were recruited from the University of Florida by means of sending invitation emails to a listserv. The advantage of this method was that it allowed students to complete the experiment at their convenience. One of a series of four links to a health r elated Web site was randomly attached to each of the invitation emails. Thus, students were randomly assigned to one of the four health Web sites and allowed to browse them online (Appendix A). The questionnaire began with an introduction that explained th e purpose of the research, the estimated time needed to complete the questionnaire, and a discussion of how the study were informed that they were free to withd raw from the study at any time without consequences.

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35 In the next section, participants were asked to read through the Web pages before completing the rest of the questionnaire. After reading the article, they responded to questions or measures related to i nformation source identification, perceived credibility, interactivity, attitude toward the Web site, and Web site evaluation. The first item on the questionnaire asked h credibility items and attitude items were presented for completion. Ten questions asked participants to indicate on a five point Likert type scale their level of agreem ent with statements about the articles and the Web site. At the end of the questionnaire, demographic information was elicited (Appendix D). Independent Variable Web S ite I nteractivity Web site interactivity was manipulated by exposing participants to eith er a high or low interactive health Web site. To ascertain participants' perception of level of interactivity of the Web sites, Web site interactivity was measured in the main questionnaire in such a way as to accommodate manipulation checks by embedding L the questionnaire. On a 5 point scale anchored by strongly disagree and strongly agree control over where I want (Table 3 3).

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36 Source C ues Source cue was an independent variable, manipulated by use of two different domains for the Web sites: .gov and .com. In order to achieve the purpo se of this experimental design, a question designed to check the manipulation ask ed respondents to identify the domain of the Web site a fter participa nts were exposed to the stimuli Dependent Variable Perceived C redibility A variety of indicators have been used in past studies to assess perceived credibility of a media message (Gaziano & McGrath 1986; Meyer 1988). Scholars addre ssing the issue have suggested that credibility is a multidimensional construct (Eastin 2001). The main focus of this study was on perceived credibility of online health information. Adopted from items developed for a study by Meyer (1988) as well as from indicators used by Eastin (2001) in his study on the credibility assessments of online health information, seven dimensions of measures were used for this study: fairness, bias, depth, accuracy, and trustworthiness, believability and factualness (Table 3 3 ). All have been demonstrated to be valid, reliable attributes by which to measure perceived credibility of a message (Gaziano & McGrath 1986; Johnson & Kaye 1998; Meyer Likert type items with scores ranging from 1 to 5. Attitude T oward the Web S ite Attitude was conceptualized as an evaluative response to the stimulus material the Web site. In this study, attitude toward a Web site was measured using a five point semanti c differential scale with regard to five questions. The items, following a study by Holbrook and Batra (1987), were anchored with unfavorable / favorable bad / good dislike / like and negative / positive (Table 3 3).

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37 Web S ite E valuation Previous studies exam ining evaluations of a Web site have emphasized three Web site evaluation dimensions: content, usability, and attitude towards the Web site (Fogg et al.,2002; Hallahan, 2001; Lynch & Horton, 2002). Because this study concerns how increased interactivity, r I (Table 3 3). The general attitude of respondents toward the Web site was gauged with a single item using a seven point scale, on which respondents were asked to rate their impression of the web site (Table 3 3)

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38 Table 3 1. Result of T test: perceived the level of interactivity. M S D N T Sig. (two tailed) Web sit e High interactivity 2.43 0.46 11 10.243 .006** Low interactivity 4.07 0.26 11 Note. *p<.05, **p<.01, ***p<.001 Table 3 2. Conditions of the 2x2 experimental design. Source cue .gov Web site .com Web site Web site interactivity High Group (1) Group (2) Limited Group (3) Group (4) Table 3 3. Construct measurement summary Variables Scale items Interactivity 1. I felt I had a lot control over where I wanted to go on the site 2. While surfing the W eb site, I had control over what I can do on the s ite. 3. The Web site makes me feel like it wants to listen to its visitors 4. The Web site gives visitors the opportunity to talk back. 5. Overall, the Web site is interactive. Credibility 1. Accurate 2. Biased 3. Believable 4. Trustworthy 5. Fair 6. Satisfactory 7. Useful Attitude 1 The Web site was favorable. 2 The Web site was positive. 3. I enjoyed exploring the site. 4. I would like to visit the site again in the future. 5. I had good impression of the Web site. Evaluation 1. I found the Web page was clear. 2. While I was on the page, I always knew where I was going. 3. I found the W eb site was to be confusing. 4. I felt disoriented while visiting this Web site. 5. The interactive features were easy to use during my exploration of the Web site.

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39 CHAPTER 4 RE SULT Analysis Summary This section provides an overview of the statistical methods and parameters employed to analyze the proposed hypotheses and explore the research questions. SPSS 17.0 was used for the statistical analysis. An independent sample t test was employed to explore H1 (source cue information credibility), H3 (interactivity information credibility), H2 (source cue attitude), and H3 (interactivity attitude). In addition, a regression analysis was run to explore the relationship between perceive d source cue, interactivity, and attitude toward the Web site. To test Hypothesis site evaluation. Then, independent simple t tests were used to compare the mean diff erences between the groups in pairs. The first section following provides descriptive statistics for all respondents involved in the experiment. The second section following is devoted to addressing the results as they related to the hypotheses. Profile of Participants The study sample included 136 university students comprised of 56% (n=76) males and 44% (n=60) females. The respondents ranged in age from 18 to 36 with a mean age of 24.24 years old. All respondents subject to analysis in this experiment wer e graduate or undergraduate students at the University of Florida. Most respondents were graduate students (55.1%), and the remainder s were undergraduates. In terms of academic classification, 9 (6.6%) were sophomores, 14 (10.2%) were juniors, 38 (27.9%) were seniors and 75 (55.1%) were graduate students. The 136 participants were randomly assigned to one of four conditions (Table 4 1). Of the respondents, 34 were in the low interactive Web site and .com source group, 34 were in the high

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40 interactive Web s ite and .com source group, 34 were in the low interactive Web site and .gov source group, and 34 were in the high interactive Web site and .gov source group. Manipulation Check To test the effectiveness of the experimental manipulation, a manipulation chec k regarding perceived level of interactivity was performed. As expected, the high interactive groups rated their sites as more interactive ( M = 3.91, SD = 0.51, n=63) compared to the low interactive groups ( M = 2.90, SD = 0.69, n= 63). Results of the independe nt sample t test (as shown in Table 4 2) showed that these differences were statistically significant, t= 9.363, P<.05 Consistently with the results of the pretest, the manipulation check for perceived level of interactivity demonstrated that the manipula tion was successful. In addition, a manipulation check for source cue was also conducted to check for potential problems related to respondents not exploring the Web site before answering the questionnaire. Among the 136 respondents, about 93% (N=126) coul d correctly identify the topic of the health information and the name of the Web site through the main page. The data from 10 participants who misidentified the source and the topics of the stimulus articles were eliminated from the subsequent analysis; th us, the total valid sample was 126. Of the valid sample, 31 were in the low interactive Web site and .com source group, 32 were in the high interactive Web site and .com source group, 32 were in the low interactive Web site and .gov source group, and 31 we re in the high interactive Web site and .gov source group (Table 4 3 ). To further test the proportion of undergraduate and graduate students in each group was no significant difference a chi square test was conducted. The result showed that t he percentag e of participants that were undergraduate students did not differ by graduate students ( 3 N = 126 ) = 0.98 p = 81(Table 4 4)

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41 Reliability Checks In order to ensure the internal reliability of the independent and dependent measures used in this study, a reliability analysis was conducted for each construct which addressed perceived sou high internal reliability. The Alpha is a coefficient that indicates how well items measuring the same characteristic correlate with one another (Hon & J. E. Grunig, 1999). Generally, reliability The results (as shown in Table 4 5 ) for the major constructs showed that the reliability of each variable was satisfactory, and that the scales were internally consistent. Regarding the independent variables, items under the category of i excess of were also confirmed to be reliable constructs. The factor structure and item means and standard deviations appear in Table 4 5. Sample Analysis The sample population for this study consisted of 136 university students. Of these, questionnaires collected from 126 were deemed valid, yielding various numbers of respondents for each conditio n Among the respondents, 99.3 % (n = 124) reported using computer for more than one year, and 71 % (n = 90) of respondents reported having been Internet users for six years or more. In addition, about 69% percent (n = 86) of respondents reported spending 2 5 hours getting general information from the Internet every day (Table 4 6 ).

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42 In terms of general usage of the Internet for health information, a sizeable portion of respondents (44 %, n = 56) reported using the Internet to look up health information a few times a year. A total of 31 % (n = 39) of respondents reported using the Internet for that purpose about once a month, 11% (n= 14) reported doing so about once a week, and 4 % (n= 5) reported doing so more than once a week. Only 10% (n=12) of responden ts reported that they never used the Internet to look up health information (as shown in Table 4 6 ). Research Questions and Hypothesis Testing Effect of Source Cue and Interactivity on Perceived Credibility H1: Participants viewing online health informati on on a .gov Web site will rate that information as being more credible than will participants viewing the same information on a .com Web site. An independent sample t test was employed to measure the difference in credibility mean scores from the two sour ces. The credibility mean score of the .gov Web site (M=3.76, SD=0.44, n=63) was significantly higher than that of the .com Web site (M=3.43, SD=0.56, n=63), suggesting that the health information from the .gov Web site was perceived as being more credible than that from the .com Web site (t= 3.73, P<.05) (Table 4 7 ). Therefore, Hypothesis 1 was supported. H2 : Participants will rate health information on high interactive Web sites as being more credible than will participants viewing the same information o n low interactive Web sites. The next set of results examined interactivity in terms of its influence on perceived credibility of online health information. The research question asked whether different levels of Web site interactivity would affect user pe rceptions of information credibility. An independent sample t test showed no significant differences attributable to interactivity ( t=1.33 n.s.) (Table 4 8 ). Thus, Hypothesis 3 was not supported.

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43 Effect of Source Cue and Interactivity on User Attitudes H 3: Participants viewing online health information from a .gov Web site will demonstrate a more positive attitude toward that Web site than those viewing the same health information on a .com Web site. In order to understand source cue effect on user attitu des toward a Web site, Hypothesis 2 predicted a more positive attitude toward a health Web site in which content was coming from a government Web site (M=3.36, SD=0.69, n=63) as opposed to a commercial Web site (M=3.08, SD=0.70, n=63) An independent sampl e t test was performed to explore how the two groups differed in terms of mean scores concerning attitude. The t test showed that the data supported Hypothesis 2 ( t= 2.25, P<.05 ) (Table 4 9 ). H4: High (versus low) interactivity will yield more favorable c onsumer attitudes toward a Web site. To examine the effect of interactivity on attitude, an independent sample t test was performed to compare the attitude mean difference between the high and low interactive groups. attitude mean score was significantly higher for the high interactive health Web site (M=3.53, SD=0.43, n=63) than for the low interactive health Web site (M=2.91, SD=0.69, n=63) (Table 4 10 ). Therefore, Hypothesis 4 was supported ( t= 5.48, p<.05 ). Effec t of Interactivity on Web S ite E valuation H5: Participants viewing online health information from a high interactive Web site will evaluate the Web site more positively in terms of usability and general attitude than those viewing a Web site with low inte ractivity. With regard to Hypothesis 5, interactivity would influence two aspects of Web site evaluation: usability and general attitude toward the Web site. Specially, it was predicted that expose to high interactivity Web site would lead to more positive evaluations of the Web site. An ANOVA was performed to determine the correlation between the two constructs The hypothesis

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44 was supported for both usability [F (1, 124) =21.64, p <.001] and general evaluation of the Web site [F(1, 124)=22.46, p <.001]. Tabl e 4 1 1 and Table 4 1 2 display the ANOVA results. In particular, t tests were performed to determine how the level of interactivity differently affected usability and general attitude mean scores. Results showed that the means for usability for a high inte ractive web site were significantly higher (M=5.36, SD=0.85, n=63) than for a low interactive web site (M=4.54, SD=1.10, n=63) ( t=4.65, P<.001 ) (Table 4 1 3 ). A second t test was performed to examine the effect of the different levels of interactivity on us the high interactive Web site (M=3.68, SD=0.76, n=63) was significantly higher than of the low interactive web site (M=3.05, SD=0.81, n=63) ( t=4.54, P<.000 ) (Tabl e 4 1 4 ). In sum, increasing interactivity seems to have stronger impact on Web site evaluation. Additional Finding Pervious results revealed that both source cue and interactivity significant related plore the suggested causal relationships between the proposed independent and dependent variables, simple linear regression analyses were employed to examine how source cue and interactivity predicted perceived attitude toward Web sites. Table 4 1 5 summari zed how the two constructs were related to consumer attitudes toward the Web sites The regression coefficient showed a positive correlation between source cue, interactivity and attitudes, and the relationship was statistically significant, R =.2 37, F (2, 123) =19.126, p<.05. The results were consistent with previous independent simple t tests. Moreover, the regression coefficient showed Web site interactivity (Beta .445) was stronger cue (Beta .205).

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45 Table 4 1. Random assignment of participants in each condition. .gov Web site .com Web site Total High interactivity N=34 N=34 N=68 Low interactivity N=34 N=34 N=68 Total N=68 N=68 N=136 Table 4 2. Result of T test: perceived the level of interactivity. M SD N t Sig. (two tailed) High interactivity 3.91 0.51 63 9.36 .000*** Low interactivity 2.90 0.69 63 Note *p<.05, **p<.01, ***p<.001 Table 4 3 Valid sample in four conditions. .gov Web site .com Web site Total Hig h interactivity n=31 n=32 n=63 Low interactivity n=32 n=31 n=63 Total n=63 n=63 n=126 Table 4 4 Cross tabulation of four conditions and academic classification A cademic c lassification Groups P Low.com High.com Low.gov High.gov Undergraduate Graduate 14 17 16 16 13 19 12 19 0.98 .81 Note *p<.05, **p<.01, ***p<.001 Table 4 5 Reliability Check Variable Mini Max Mean Web site interactivity 3.32 3.50 3.41 .90 Perceiv ed credibility 3.44 3.80 3.60 .85 Usability 4.73 5.19 4.94 .89 Attitude toward the web site 2.79 3.50 3.22 .92

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46 Table 4 6 General usage of Internet Frequency Percent Years for being an internet user A year ago 2 0.7% Two or three years ago 9 6. 9% Four years ago 12 9.1% Five years ago 13 9.3% Six years or more 90 71% Total 126 100% Average hours on getting information from the internet everyday 1 23 18% 2 5 86 69% 6 10 13 10% More than 10 4 3% Total 126 100% Usage of internet to look up medical information Never 12 10% A few times a year 56 44% About once a month 39 31% About once a week 14 11% More than once a week 5 4% Total 126 100% Table 4 7 Result of T test: source cue information credibility. M S D N T Sig. (two tailed) Source cue .com 3.43 0.56 63 3.73 .012* .gov 3.76 0.44 63 Note .1. Dependent variable: information credibility 2. *p<.05, **p<.01, ***p<.001 Table 4 8 Result of T test: Interactivity information credibility M S D N T Sig. (two taile d) Interactivity High (web site) 3.66 .51 63 1.33 .n.s Low (web site) 3.54 .54 63 Note.1. Dependent variable: information credibility 2. *p<.05, **p<.01, ***p<.001

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47 T able 4 9 Result of T test: source cue attitude M S D N T Sig. (two tailed) Source cue .com(web site) 3.08 .70 63 2.25 .026* .gov (web site) 3.36 .69 63 Note .1. Dependent variable: consumer attitude toward Web site 2. *p<.05, **p<.01, ***p<.001 Table 4 10 Result of T test: Interactivity attitude M S D N T Sig. (two tailed) Inter activity Low (web site) 2.91 .69 63 5.48 .000*** High (web s ite) 3.53 .58 63 Note .1. Dependent variable: consumer attitude toward Web site 2. *p<.05, **p<.01, ***p<.001 Table 4 1 1 Effects of Source & Interactivity on Perceived Usability Source of var iation Sum of squares d f f Significance Source .09 1 .09 N.s Interactivity 21.00 1 21.64*** .000 Source*interactivity .29 1 .30 N.s Note. N=126, *p<.05, **p<.01, ***p<.001 Table 4 1 2 Effects of Source & Interactivity on general attitude towar d Web site Source of variation Sum of squares d f f Significance Source 12.92 1 7.07 N.s Interactivity 21.00 1 22.46*** .000 Source*interactivity 2.22 1 3.86 N.s Note. N=126, *p<.05, **p<.01, ***p<.001 Table 4 1 3 Result of T test: Interactivi ty usability N S D M T Sig. Interactivity Low (web site) 63 1.10 4.54 4.65 .000*** High (web site) 63 .85 5.36 Note .1. Dependent variable: usability 2. *p<.05, **p<.01, ***p<.001 Table 4 1 4 Result of T test: Interactivity general attitude N S D M T Sig. Interactivity Low (web site) 63 .81 3.05 4.54 .000*** High (web site) 63 .76 3.68 Note .1. Dependent variable: general attitude 2. *p<.05, **p<.01, ***p<.001

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48 Table 4 1 5 Regression analysis of consumer attitude toward the Web site Dependent variable: attitude toward the web site R R Adjusted R F Sig. Beta T Sig. m odel Perceived source cue .49 .24 .23 19.14 .000*** .22 2.61 .010* Perceived interactivity .46 5.61 .000*** Note. 1. p < .05, ** p < .01, *** p < .001

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49 CHAPTER 5 DISCUSSION AND CONCL USION The chapter begins with a summary of the present study, followed by a detailed analysis of conclusions related to the hypotheses. Next, a discussion of the implications for theoretical and practical perspectives is provided. F inally, the chapter concludes with limitations and recommendations for future research. Summary The present study combined the concept of source credibility and interactive feature cues to better understand how consumers process information and how these factors jointly affect the perceptions of online health information credibility, as well as the attitude consumers have toward Web site and Web site evaluation. One focus of this research was to investigate how consumers respond to two different sources of information and form attitudes toward the Web sites. Two distinct sources of information were examined in this study, including .gov and .com. have examined individual elements of site presentation such as navigation, interactivity, and links, in terms of credibility assessment. However, little research has empirically addressed the key issues of the overall level of interactivity and its effect on perceived credibility, attitude toward a Web site, and evaluation. Therefore, both source cue and the level of interactivity were simultaneously examined in this study. An experimental design was employed to test the concept idea which discuss above. Participants were exposed to health information attributed to a source form either a .gov or .com website. The Websites they explored were also portrayed as either from a company with high interactivity or one with limited interactivity. A professional Web designer cre ated a fictitious

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50 attitudes toward a Web site, and Web site evaluation were influenced by their assessments of interactivity and source cue. The results of the study indicated several important findings. First, there was a statistically significant positive correlation between source cue and perceived information credibility. The finding indicated that source cue has a positive effect on perceived information credibil ity. In other words, respondents considered the source of health information provided from a government Web site was deemed significantly more credible than a commercial Web s sender is. In interactivity effect consumer's attitude toward Health Web sites. Furthermore, interactivity had a more significant influence on consumer's attitude towar d Health Web sites than source cue. Additionally, increased interactivity could lead to more positive evaluations of the Web site. In sum, the more interactive features such as navigation menus and chat rooms, the more positive toward the Web site and the evaluation. From the health communication perceptive, this study allows for greater understanding of the source cue and interactive features on health Web sites. This study could inform the work of scholars interested in exami ning information credibility of health Web sites as well as aid in understanding the strategic use of interactive features in maintaining positive attitudes. As concern for finding credible online health information grows (Pew study & American Life Project 2000), knowing how consumers determine the credibility of health Web sites and building a positive consumer attitude toward organizations will garner more importance. Overview of Hypothesis To better understand the findings, each of the five hypotheses is discussed in detail based on the results of this study.

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51 Hypothesis 1 was supported. The data showed that source cue was significantly related to perceived information credibility. These results contrasted with those of previous studies, which observe d a positive impact of identify source on determined credibility and quality of information (Eysenbach & Kohler, 2002). Participants who received the health message from a government Web site evaluated the message to be more trustworthy, believable, or acc urate than the health message from a .com Web site. Due to the lack of publication controls on the Web, users may look for trustworthy credibility markers such as a reputable institutional as a source. Following by the Elaboration Likelihood Model (Petty & Cacioppo, 1986) readers judge the they have less motivated, personal relevance, and knowledge about a given topic. Therefore, a positive relationship between source cue and perceived information credibility might be more easily observed when respondents encounter an unfamiliar topic. Since the stimulus articles in this study presented a health topic related to depression, the effect of a source cue might be a m Hypothesis 2 anticipated that Web site interactivity predicts perceived information credibility; however, this was not supported. There was no difference in credib ility between highly interactive Web sites and limitedly interactive Web sites. This finding was surprising because they run counter to what the literature predicted. Although previous research has suggested a positive association between perceived credibi lity and interactive features, the simple independent t tests in this study indicated that for both source cue and interactivity, only source cue significantly predicts perceived information credibility. This would tend to indicate that the participants d site as an important factor in their determination of information credibility. Instead, the source

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52 cue plays a more important role. In addition, whether participants use the intera ctive features on the Web site or not may influence their perceptions of credibility assessment. The influence of interactivity on credibility assessment may be observed when participants used interactive content (Kiousis, 2003). Hypothesis 3 stated that the source is positively related to consumer attitude about the Web site. Consistent with the body of extant literature, companies with highly credible sources indeed yielded positive consumer attitudes compared to those with lowly credible sources (Hovla nd & Weiss, 1951; Lafferty et al., 2002; MacKenzie & Lutz, 1989). The present study confirmed the effects of site sponsors on perceived credibility and attitude toward Web sites in the field of health communication. Specifically, the government Web site wo uld be perceived as users who possess higher levels of determining information credibility. Thus, the higher perceived information credibility can lead to more favorable attitudes toward a Web site. Regarding Hypothesis 4, it was found that interactivi ty is positively related to attitudes toward the Web site. Based on extensive regression analyses, the results demonstrated a strong and highly predictable relationship between perceived interactivity and consumer attitude toward the health Web site. It wa s consist with previous study, the more interactive features that present, improved toward the health Web site ( Lustria, 2007 ). Hypothesis 5 explored the effect of interactivity on Website evaluation. The data showed that interactivity was significantly related to Website evaluation. Highly interactive Web sites lead to a higher rating of evaluation than limited Web sites. The hypothesis was supported by both usa bility and general evaluation of the health Web site. This implies that interactivity may play an important role in evaluating different aspects of Web sites as well as creating a more

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53 positive impression of the health Web site. In sum, a highly interactiv e Web site affects not only the attitude toward the Web site, but also impacts the Web site evaluation. Conclusion and Implication Different factors in predicting perceptions of online health information credibility have long been of interest to scholars and marketers. Grounded on a proposed concept that considers both source and Web site interactivity cues applied by consumers to evaluating information and forming attitudes, this study provided empirical results about the differences in perceived credibi lity across different genres of Web sites. One of the important findings in this study is that there is a difference in perceived credibility between a health messag e coming from a government Web s ite or a commercial Web site. It highlighted and tested several relationships among important different source cues and their connections to persuasion. Previous research has showed that users generally consult only the most popular site or sites of health related information found through general Internet sear ch engines (Morahan Martin, 2001). When there is a variety of health information available from credible and incredulous sources of health information. However that when evaluating health information on the Internet, users did take source credibility into greater account. Participants who received the health message from a government Web site consider the information more credibl e than from a .com Web site. This implies that government Web sites reflect a trustful provider in seeking out high quality information on the Internet. Another meaningful finding, this research contributed to understanding of the attitude change process based on both sources and interactivity cues. The result demonstrated that consumer attitude is highly related to Web site interactivity. Meanwhile, attitude could be changed positively by providing information from highly credible sources. It builds posi tive

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54 attitudes between corporations and consumers depending on the perceived trustworthiness and expertise of a given source. From a theoretical standpoint, this study provides an additional explanation of how these two factors influence information proces sing and attitude formation. Furthermore, this represents the most important contribution toward our understanding of In terms of relevant, practical implications, companies pay lots attention to es tablishing showed that increased Web site interactivity also impacts perceived usability and general evaluation of the health Web site. Participants tend to evaluat e a health Web site with more interactive features as easier to use, better organized, and more functional. This implies that interactivity may play an important role in attracting health information seekers and in maintaining their attention. In other wor ds, it seems that a health Web site with highly interactive functions lead to a more positive impression and engagement among the users. Therefore, the presentation of Web site becomes a focal point if organizations seek to elicit favorable attitudes from or build long term relationships with customers and other stakeholders. For health communication practitioners who try to create positive images online, increasing the interactive features on the Web page may be a good way to achieve their goals. In sum mary, the credibility of online health information has become of significant concern to health communication professionals and consumers Many studies have examined the role of various elements in predicting perceptions of information credibility in the on line environment (Burkell, 2004; Flanagin & Metzger, 2000; Fogg, 2003; Fogg et al., 2001; Hong, 2006; Nettleton et al., 2004) but little research has empirically addressed the key issues of source cue and interactivity in terms of credibility and its effe ct on attitude toward a Web site. To

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55 bridge such a gap, this study attempted to empirically examine the effects of different source cues and interactivity on perceived information credibility and attitude toward a Web site. In addition, the present study t ested whether the level of interactivity can improve the evaluation of a Web site. The results yielded inspiring conclusions that a government Web site could serve as an effective communication resource to foster trust. Moreover, the results indicated that taking advantage of more interactive features in the Website has beneficial effects on the consumers. Finally, overall Website evaluation seems to have important implications for health communication practitioners because those overall perceptions are lik ely to increase Limitations and Future Research Despite the implications, there are some limitations worth consideration in the present study. An experimental design is appropriate for this researc h; it allows controls for variables regarding source credibility and interactive features, and thus enables the researcher to observe the effect of interactive features and perceived source expertise on information credibility. The employment of real world health information in the experiment provided external validity. However, using a fictitious Website to display it did not truly resemble those actually encountered by respondents in the natural condition. Thus, one might argue that the perceived credibil ity and subsequent attitude change based on these materials cannot be applied to real world situations. Future studies should attempt to replicate the study employing real health Web sites. Also, scholars recommend triangulation for studying new media (Wil liams, Rice & Rogers, 1998), and other methodology should be adopted for future research in this area. For example, qualitative designs (e.g. interviewing), could be consider an alternative approach to better understand the way consumers search for health related information and to clarify the difference in perceived information credibility among different sources.

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56 Moreover, the study finding confirmed a significant relationship between the level of ebsites. However, Interactivity here was narrowly defined by actor control (navigation menu and hyperlink) and two way communication ( feedback forms chat room and e mail), and yet did not include all the possible features that could make Websites truly in teractive such as modality content (e.g., Sims, 1995) audio or video downloads register devices, etc. Future analysis should continue to investigate the impact of interactivity on assessments of credibility by enhancing the level of Web site interactivit y. Also, it is unclear what feature attracts and engages users most. It is also needed to examine what particular features of Web sites contribute to more positive attitudes towards the site for future research. Furthermore, the data showed participants w ho received the health message from a government Website did evaluate the message to be more credible than the health message from a .com Website. The commercial Web site was a relatively low credibility assessment because of the implied commercial self in terest of the site sponsors (Wather, Wnag & Loh, 2004). However, there are various types of Web sites available on the Internet for providing health information. For example, users would probably be more likely to visit sites recommended by peers; it is kn ow that educational Websites receive more referrals among students (Metager, 2002). It would be interesting to explore perceived information credibility based on the various sponsors of Websites such as .org and .edu. It must be noted that the student samp le do not represent the whole population. Although students are the heaviest groups of Internet users (Eastin, 2001), who use the Internet as their information sources than other subject groups they can only reveal a narrowed scope of consumer perceptions and behaviors. Their perceptions of credible online health information are

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57 also different from that of people from other generations; this is another limitation of this research. Therefore, the results of present study cannot be generalized beyond this sp ecific population Replicating the present study with more representative samples could enrich future studies. In addition, future studies would be valuable to test the impact of interactivity levels on perceptions of credibility and positive attitudes in a more heterogeneous sample. Different characteristics (e.g. age, race, socioeconomic status, educational attainment), may directly or indirectly affect performance in online environment. B nvironment, other conditions should be considered. For example, user factors such as the purpose and motivation for information search, prior knowledge, and Internet experience also influence the perceptions of credibility during an evaluation (Fogg et al. 2003). While consumers search or surf for the online health information, they may perceive the content of Web sites differently; their motivation may influence those using interactive applications, which may facilitate or impede perceptions of credibilit y. Kahle and Homer (1985) found that the level of involvement with the issue influences the information and evaluation. To illustrate, factors having to do with site content and source were relevant to judgments of site credib ility, whereas factors such as audience will likely be equally important in assessment of the credibility of health website. Thus, future studies concerned with the influence of source and interactive feature should also consider the control of the audienc e factors. In conclusion, the results of this study suggest several areas for future research. Studies should continue to investigate the impact of source cue and interactivity on assessments of online health information credibility. Increasing understan ding of the ways that consumers determine

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58 the quality of online health information will help publishers produce a more trusted and accepted messages.

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59 APPENDIX A WEBSITE LAYOUT Figure A 1. High interactive health Web site layout for government source. http://www.cise.ufl.edu/~ystsai/Dora/highgov/What_is_depression.html

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60 Figure A 2. Limited interactive health Web site layout for government source. http://www.cise.ufl.edu/~ystsai/Dora/lowgov/2.html

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61 Figure A 3. High interactive health Web site layout for commercial source http ://www.cise.ufl.edu/~ystsai/Dora/highcom/What_is_depression.html

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62 Figure A 4. Limited interactive health Web site layout for commercial source. http://www.cise.ufl.edu/~ys tsai/Dora/lowcom/What_is_depression.html

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63 APPENDIX B HEALTH INFORMATION P OST ON WEB SITE: DEP RSSION Centers for Disease Control and Prevention (CDC, 2009) What I s D epression? Everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Depression is a common but serious ill ness, and most who experience it need treatment to get better. Many people with a depressive illness never seek treatment. But the vast majority, even those with the most severe depression, can get better with treatment. Intensive research into the illnes s has resulted in the development of medications, psychotherapies, and other methods to treat people with this disabling disorder. What C auses D epression? There is no single known cause of depression. Rather, it likely results from a combination of geneti c, biochemical, environmental, and psychological factors. Research indicates that depressive illnesses are disorders of the brain. Brain imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depressio n look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally. In addition, important neurotransmitters chemicals that brain cells use to communicate appear to be out of balance. But these images do not reveal why the depression has occurred. Some types of depression tend to run in families, suggesting a genetic link. However, depression can occur in people without family histories of dep ression as well. Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental or other factors. In addition, trauma, loss of a loved one, a difficult relationship, or any stressful sit uation may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger. What Are The Symptoms of Depression? People with depressive illnesses do not all experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness S ymptoms :

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64 Feelings of hopelessness and/or pessimism Feelings of guilt, worthlessness and/or helplessness Irritabil ity, restlessness Loss of interest in activities or hobbies once pleasurable, including sex Fatigue and decreased energy Difficulty concentrating, remembering details and making decisions Insomnia, early morning wakefulness, or excessive sleeping Over eating, or appetite loss Thoughts of suicide, suicide attempts Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment How Can I Help a Friend or Relative Who Is Depressed? If you know someone who is depres sed, it affects you too. The first and most important thing you can do to help a friend or relative who has depression is to help him or her get an appropriate diagnosis and treatment. You may need to make an appointment on behalf of your friend or relativ e and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if no improvement occurs after six to eight weeks. Help a friend or relative: Offer emotional support, understanding, patience and encoura gement. Engage your friend or relative in conversation, and listen carefully. Never disparage feelings your friend or relative expresses, but point out realities and offer hope. therapist or doctor. Invite your friend or relative out for walks, outings and other activities. Keep trying if he diversions and company are needed, too many demands m ay increase feelings of failure. Remind your friend or relative that with time and treatment, the depression will lift.

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65 A PPENDIX C INSTRUCTIONS TO SUBJ ECTS Dear Student: My name is ChiaLun Lee and I am a graduate student working under the supervisi on of Dr. Lee. You are being asked to participate in an experiment designed to responses to online health information. You will be asked to view a Health Web site and to indicate your thoughts and feelings about the Web site. This resear ch project was designed solely for research purposes and no one except the research team will have access to any of your responses. All responses will be kept confidential. The survey is anonymous. Your participation in this project is voluntary. You d o not have to answer any question(s) that you do not wish to answer. Please be advised that you may choose not to participate in this research, and you may withdraw from the experiment at any time without consequence. Non participation will not affect your grade. There is no direct benefit or compensation for participation. This experiment will take approximately 20 minutes during your regularly scheduled class time. There are no anticipated risks associated with participation. If you have any questions or comments about this research, please contact chialun, lee, college of Journalism and Communications University of Florida, 352 870 3426/buzz1020@ufl.edu. Questions or concerns about research participants' rights may be directed to the UFIRB office, Bo x 112250, University of Florida, Gainesville, FL 32611 2250; phone 392 0433. Sincerely, Chialun Lee Agreement: I have read the document stating the procedures to be used and followed in this study. I AGREE to participate in the study PLEASE CLICK ON N EXT BELOW IF YOU AGREE WITH THE ABOVE INFORMATION.

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66 APPENDIX D QUESTIONNAIRE FOR PR ETEST INTRODUCTION Thank you for taking time to participate in this study. The purpose of this research is to check if consumers can perceive a significant differe nce in the level of interactivity on a Website. Please read the following questions carefully, and check one choice from the scale that best describes your thoughts or feelings. Your answers will be used only for statistical purposes and will remain strict ly confidential. Thank you! Section 1. How do you agree/disagree with the following statements? 1. I felt that I had a lot of control over my experiences at this web site. Strongly disagree (1) (2) ( 3) (4) (5) (6) (7) Strongly agree 2. While I was on the Web site, I could choose freely what I wanted to see. Strongly disagree (1) (2) (3) (4) (5) (6) (7) Strongly agree 3. While surfing the website, I had control over what I can do on the site. Strongly disagree (1) (2) (3) (4) (5) (6) (7) Strongly agree 4. The Web site makes me feel like it wants to listen to its visitors Strongly disagree (1) (2) (3) (4) (5) (6) (7) Strongly agree 5. The Web site gives visitors the opportunity to talk back. Strongly disagree (1) (2) ( 3) (4) (5) (6) (7) Strongly agree Section 2. Demographics 1. Gender: ( ) Male ( ) Female 2. Age: _______ 3. Current level of education: ( ) Freshman ( ) Sophomore ( ) Junior ( ) Senior or post baccalaur eate ( ) Graduate Student Thank you very much for your participation!

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67 APPENDIX E QUESTIONNAIRE FOR EX PERIMENT GROUP INTRODUCTION opinions on the online heal th information you just read. Please circle the number that best describes your thoughts or feelings. Your answers will be used only for statistical purposes and will remain strictly anonymous to the extent provided by law. Please read the instructions and questions carefully. Section 1. Please answer the following questions. 1. The health information is taken from the Web. Please indentify the name of Web site. Health.gov [ ] Health.com [ ] Not Sure [] 2. What is the health information d iscussed in the Web site? Diabetes [ ] Depression [ ] Breast Cancer [ ] Section 2. Evaluation of Credibility Please evaluate the health information you just read about the following statements. 1. The health information presented in this Web s ite was accurate. Not at all accurate (1) (2) (3) (4) (5) Very accurate 2. The health information presented in this Web site was biased. Complete bias (1) (2) (3) (4) (5) No bias 3. The healt h information presented in this Web site was believable. Not at all believable (1) (2) (3) (4) (5) Very believable 4. The health information presented in this Web site was trustworthy. Not at all trustworthy (1) (2 ) (3) (4) (5) Very trustworthy 5. The health information presented in this Web site was fair. Not at all fair (1) (2) (3) (4) (5) Very fair 6. The depth of the health information was satisfactory. Strongly d isagree (1) (2) (3) (4) (5) Strongly agree 7. The health information presented in the Web site was useful. Not at all useful (1) (2) (3) (4) (5) Very useful Section 3. Your Opinions about the Web site After reading the health in formation, please evaluate how you feel about Web site by circling a number on each of the scales below. 8. The Web site was favorable. Strongly disagree (1) (2) (3) (4) (5) Strongly agree

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68 9. The web site was positive. Strongly disagree (1) (2) (3) (4) (5) Strongly agree 10. I enjoyed exploring the site. Strongly disagree (1) (2) (3) (4) (5) Strongly agree 11. I would like to visit the site again in the future. Strongly disagree (1) (2) (3) ( 4) (5) Strongly agree 12. I had good impression of the Web site. Strongly disagree (1) (2) (3) (4) (5) Strongly agree Section 4. Your Reactions to the Website How do you agree/disagree with the following statements? 13. While I was on th e Web site, I could choose freely what I wanted to see. Strongly disagree (1) (2) (3) (4) (5) Strongly agree 14. While surfing the website, I had control over what I can do on the site. Strongly disagree (1) (2) (3) (4 ) (5) Strongly agree 15. The Web site makes me feel like it wants to listen to its visitors Strongly disagree (1) (2) (3) (4) (5) Strongly agree 16. The Web site gives visitors the opportunity to talk back. Strongly disagree (1) (2) (3) (4) (5) Strongly agree 17. Overall, the Web site is interactive. Strongly disagree (1) (2) (3) (4) (5) Strongly agree How do you agree/disagree with the following statements? 18. I found the Web page was clear. Strongly disagree (1) (2) (3) (4) (5) (6) (7) Strongly agree 19. While I was on the page, I always knew where I was going. Strongly disagree (1) (2) (3) ( 4) (5) (6) (7) Strongly agree 20. I found the Web site was to be confusing. Strongly disagree (1) (2) (3) (4) (5) (6) (7) Strongly agree 21. I felt disoriented while visiting this Web site. Strongly disagree (1) (2) ( 3) (4) (5) (6) (7) Strongly agree 22. The interactive features were easy to use during my exploration of the Web site. Strongly disagree (1) (2) (3) (4) (5) (6) (7) Strongly agree Section 6. Please answer the following question 1. About how many years have you been an internet user?

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69 A year ago [ ] Two or three years ago [ ] Four years ago [ ] Five years ago [ ] Six years or more [ ] 2. What is the average number of hours you spend on getting news or information from th e Internet everyday? 0 [ ] 1 [ ] 2 5 [ ] 6 10 [ ] more than 10 [ ] 3. Have you ever use the Internet to look up medical information? Never [ ] A few times a year [ ] About once a month [ ] About once a week [ ] More than once a week [ ] Section 7. Demographics 1. Gender Male [ ] Female [ ] 2. Age _______ 3. What is your current class standing? [ ] Freshman [ ] Sophomore [ ] Junior [ ] Senior or post baccalaureate [ ] Graduate Student THANK YOU VERY MUCH FO R YOUR PARTICIPATION!

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78 BIOGRAPHICAL SKETCH Chia Lun Lee was born in Taoyuan, Taiwan. In 2007, she obtained her B achelor of A rt in M ass C ommunication degree with specializatio n in journalism from Ming Chuan University, one of the most prestigious colle ges of mass communication in Taiwan. She joined the graduate program of the College of Journalism and Communication at the University of Florida in fall 2008. In summer 2010, she received a M aster of A rt in Mass Communication with specialization in public relations During her graduate studies, she focused on online media, health communication and corporate social responsibility. After graduation, she plans to continue her public relations career in Taiwan by becoming involved in practical areas of public relations.