The Effects of Health Literacy on Electronic Word of Mouth in Health Information Dissemination: The Moderating Role of Health Communication Competence

Articles in Press

Document Type : Original Article

Authors

1 Faculty of Business and Management, Universiti Teknologi MARA (UiTM) Selangor Branch, 42300 Puncak Alam, Selangor, Malaysia.

2 Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Wilayah Persekutuan Kuala Lumpur.

Abstract

Background and Objectives: The transition to electronic communication from conventional methods has resulted in a natural shift from word-of-mouth to electronic word-of-mouth. The dynamics of electronic platforms has opened a new dimension for the society to ‘responsibly’ involve more in health information sharing to ensure that everyone has equal accessibility to health information. The main objective of this research was to examine the moderating effect of health communication competence on the relationship between health literacy and electronic word of mouth (e-WOM) in health information dissemination among Malaysia internet users. 

Materials and Methods: This descriptive study has applied cross-sectional time horizon as it was intended to identify the relationship between health literacy and electronic word of mouth in health information sharing among Malaysia internet users. 400 samples were approached as the respondents in which each major region of Malaysia has represented by 100 respondents. The instrument was a self-administered questionnaire with 56 items, adapted from New Short-Form Health Literacy Instrument (HLS-SF12), e-WOM questionnaire and CoCo questionnaire for health communication competence items.

Results: The study has indicated Malaysia internet users have higher percentage of sufficient health literacy and its domains, compared to the to Malaysia Health Literacy Survey (MHLS) 2023. The results also found that health literacy and its three domains were significantly, positively and largely related to electronic word of mouth (e-WOM) in disseminating health information. Besides, the study has discovered the moderating effects of health communication competence on the relationship between the independent and dependent variables, with a significant interaction term in between disease prevention and health communication competence. 

Conclusion: Based on the study’s findings, the level of health literacy among internet users was sufficiently favorable and is expected to increase from time to time. Thus, it is advisable for the public health authorities to take advantage of this whole scenario of health literacy significance in influencing e-WOM among the society, especially future has foreseen a great impact of technology advancement in sharing important health information via the convenience of internet. 

Keywords

Acknowledgement: We would like to thank the Malaysia Ministry of Higher Education, Universiti Teknologi MARA (UiTM) and Research Management Centre (RMC) of UiTM for funding this study through internal grant DUCS-F 600-UiTMSEL (Pl. 5/4) (100/2022).


Availability of data and materials: The materials and data supporting this study are available from the corresponding author upon reasonable request.


Conflicts of interest: There is no conflicting interest that the authors would like to declare regarding the publication of this article.


Consent for publication: Each author consents to the publication of the manuscript in its current form.


Ethics approval and consent to participate: The ethical approval was obtained from the UiTM Research Ethic Committee [REC/02/2023 (ST/MR/45)]. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Participants were fully informed regarding study objectives and written/ verbal consent was obtained before the initiation of the data collection. The study was done based on voluntary basis where no sort of coercion was applied to participants in the research process. Strictest confidentiality of the data was fully maintained and collected data is used only for the research purpose.  


Funding: Special gratitude goes to the Malaysia Ministry of Higher Education, Universiti Teknologi MARA (UiTM) and Research Management Centre (RMC) of UiTM for funding this study through internal grant DUCS-F 600-UiTMSEL (Pl. 5/4) (100/2022).


Authors’ contribution: NAS has contributed in writing all parts of the manuscript while SEWP has contributed in analyzing the collected data and interpreted the findings.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

  1. Centers for Medicare & Medicaid Services. Health equity: Centers for Medicare & Medicaid Services; 2024 [Available from: https://www.cms.gov/pillar/health-equity#:~:text=To%20CMS%2C%20health%20equity%20means,preferred%20language%2C%20or%20other%20factors.
  2. Shahid R, Shoker M, Chu LM, Frehlick R, Ward H, Pahwa P. Impact of low health literacy on patients' health outcomes: a multicenter cohort study. BMC Health Services Research. 2022;22(1):1148. https://doi.org/10.1186/s12913-022-08527-9 PMid:36096793 PMCid:PMC9465902
  3. Murray M, Smith C, Behan S, Goss H. Healthy Communities Health Literacy Report 2024. Dublin: School of Health and Human Performance, Dublin City University; 2024 3rd May 2024.
  4. Ministry of Health Malaysia. National Health Literacy Policy. Putrajaya: Ministry of Health Malaysia; 2024.
  5. Lee HY, Jin SW, Henning-Smith C, Lee J, Lee J. Role of Health Literacy in Health-Related Information-Seeking Behavior Online: Cross-sectional Study. J Med Internet Res. 2021;23(1):e14088. https://doi.org/10.2196/14088 PMid:33502332 PMCid:PMC7875696
  6. Manganello J, Gerstner G, Pergolino K, Graham Y, Falisi A, Strogatz D. The Relationship of Health Literacy With Use of Digital Technology for Health Information: Implications for Public Health Practice. J Public Health Manag Pract. 2017;23(4):380-7. https://doi.org/10.1097/PHH.0000000000000366 PMid:26672402
  7. Paige SR, Krieger JL, Stellefson ML. The Influence of eHealth Literacy on Perceived Trust in Online Health Communication Channels and Sources. J Health Commun. 2017;22(1):53-65 https://doi.org/10.1080/10810730.2016.1250846 PMid:28001489 PMCid:PMC5551054
  8. Tam C, Loureiro A, Oliveira T. The individual performance outcome behind e-commerce. Internet Research. 2020;30(2):439-62. https://doi.org/10.1108/INTR-06-2018-0262
  9. Katz E, Lazarsfeld PF. Personal influence: The part played by people in the flow of mass communications. Piscataway, NJ: Transaction Publishers; 1966.
  10. Melander T, Dyrelöv F. The impact of negative ewom on brand loyalty: a qualitative study in the context of social media: Umeå School of Business and Economics; 2021.
  11. Luo MM, Chien C-C, editors. Factors Affecting Negative E-WOM: A Literature Review and Merged Model. 54th Hawaii International Conference on System Sciences; HICSS '21; 2021; Kauai, HI. https://doi.org/10.24251/HICSS.2021.514
  12. Gong Y, Wang H, Xia Q, Zheng L, Shi Y. Factors that determine a Patient's willingness to physician selection in online healthcare communities: A trust theory perspective. Technology in Society. 2021;64:101510. https://doi.org/10.1016/j.techsoc.2020.101510 PMid:36033357 PMCid:PMC9398493
  13. Li S, Feng B, Chen M, Bell RA. Physician review websites: effects of the proportion and position of negative reviews on readers' willingness to choose the doctor. J Health Commun. 2015;20(4):453-61 https://doi.org/10.1080/10810730.2014.977467 PMid:25749406
  14. Reddy BV, Gupta A. Importance of effective communication during COVID-19 infodemic. J Family Med Prim Care. 2020;9(8):3793-6. https://doi.org/10.4103/jfmpc.jfmpc_719_20 PMid:33110769 PMCid:PMC7586512
  15. Márquez-Díaz JE. Disinformation and Fake News: The Infodemic in the Global Health Field. Computación y Sistemas. 2024;28(3):909-22 https://doi.org/10.13053/cys-28-3-4455
  16. Sood S, Riley AH, Obregón R. Defining Public Health Communication. In: Sood S, Riley AH, editors. Health Communication Fundamentals: Planning, Implementation, and Evaluation in Public Health. New York: Springer Publishing Company; 2023. p. 1-30. https://doi.org/10.1891/9780826173027
  17. Ghasemi SS, Olyaie N, Shami S. An investigation into the correlation between emotional intelligence and communication skills among nursing students. Indian Journal of Forensic Medicine & Toxicology. 2018;12(3):178-83 https://doi.org/10.5958/0973-9130.2018.00155.X
  18. Amini M, Amini M, Nabiee P, Delavari S. The Relationship Between Emotional Intelligence and Communication Skills in Healthcare Staff. Shiraz E-Medical Journal. 2018;20(4):e80275 https://doi.org/10.5812/semj.80275
  19. Gül N. Relationship between emotional intelligence and communication skills of healthcare workers. Journal of Academic Researches and Studies. 2021;13(25):457-65. https://doi.org/10.20990/kilisiibfakademik.972072
  20. New Straits Times. Malaysia ranks 3rd in world for spending most time online. New Straits Times. 2023.
  21. Wang X, Cheng Z. Cross-sectional studies: strengths, weaknesses, and recommendations. CHEST. 2020;158(1S):S65-S71 https://doi.org/10.1016/j.chest.2020.03.012 PMid:32658654
  22. Salkind NJ. Exploring Research. 8th ed. New Jersey: Pearson Education, Inc.; 2012.
  23. Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate Data Analysis. 8th ed. United Kingdom: Cengage Learning; 2018.
  24. Duong TV, Aringazina A, Baisunova G, Pham TV, Pham KM, Truong TQ, et al. Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries. Journal of epidemiology. 2017;27(2):80-6. https://doi.org/10.1016/j.je.2016.09.005 PMid:28142016 PMCid:PMC5328731
  25. Farin E, Schmidt E, Gramm L. Patient communication competence: Development of a German questionnaire and correlates of competent patient behavior. Patient education and counseling. 2014;94(3):342-50 https://doi.org/10.1016/j.pec.2013.11.005 PMid:24332119
  26. Wan Zulkiffli WF, Lu MH, Ramlee SIF, Mat Yunoh MN, Che Aziz R. The Effectiveness of Electronic Word-Of-Mouth (eWOM) on Consumer Purchase Intention Among Generation-Y. International Journal of Accounting, Finance and Business. 2017;2(6):18-26.
  27. Konting MM, Kamaruddin NB, Man NA. Quality Assurance in Higher Education Institutions: Exist Survey among Universiti Putra Malaysia Graduating Students. International Education Studies. 2009;2(1):25-31. https://doi.org/10.5539/ies.v2n1p25
  28. Malaysia Department of Statistics. ICT USE AND ACCESS BY INDIVIDUALS AND HOUSEHOLDS SURVEY REPORT 2023. Putrajaya: Department of Statistics, Malaysia 2024.
  29. The Star. New RM1,700 minimum wage takes effect today. The Star. 2025 1 February 2025.
  30. Institute for Health Behavioural Research (IHBR). Fact Sheet Malaysia Health Literacy Survey (MHLS) 2023. Selangor, Malaysia: Institute for Health Behavioural Research; 2024.
  31. De Santis KK, Jahnel T, Sina E, Wienert J, Zeeb H. Digitization and Health in Germany: Cross-sectional Nationwide Survey. JMIR Public Health Surveill. 2021;7(11):e32951. https://doi.org/10.2196/32951 PMid:34813493 PMCid:PMC8612128
  32. Cohen J. Statistical power analysis for the behavioral sciences (2nd ed.). Hilsdale, NJ: Lawrence Earlbaum 1988.
  33. Johari MZ, Sanusi NHA, Perialathan K, Mien TYS, Ahmad M, Isa A, et al. Research Highlight: Towards Better Health Literacy Status in Malaysia. Malaysia Health Literacy Survey (MHLS 2023). Institute for Health Behavioural Research (IHBR); 2024.
  34. Li, Lv X, Liang J, Dong H, Chen C. The development and progress of health literacy in China. Front Public Health. 2022;10:1034907. https://doi.org/10.3389/fpubh.2022.1034907 PMid:36419995 PMCid:PMC9676454
  35. Hong M, Huang X, Ge Z. Engagement of Electronic Word-of-Mouth on M-Health Platforms. Human-Centered Design, Operation and Evaluation of Mobile Communications: 5th International Conference, MOBILE 2024, Held as Part of the 26th HCI International Conference, HCII 2024, Washington, DC, USA, June 29-July 4, 2024, Proceedings, Part I; Washington DC, USA: Springer-Verlag; 2024. p. 31-44 https://doi.org/10.1007/978-3-031-60458-4_3
  36. Diviani N, van den Putte B, Giani S, van Weert JCM. Low Health Literacy and Evaluation of Online Health Information: A Systematic Review of the Literature. J Med Internet Res. 2015;17(5):e112. https://doi.org/10.2196/jmir.4018 PMid:25953147 PMCid:PMC4468598
  37. Yang Y, Adnan HM, Alivi MA. Predictors of health preventive behavior among university students in the post-COVID-19 era in Wuhan via TikTok journeying. Heliyon. 2024;10(21):e39092. https://doi.org/10.1016/j.heliyon.2024.e39092 PMid:39524767 PMCid:PMC11550071
  38. Choi DH. The multifaceted impact of social media on risk, behavior, and negative emotions during the COVID-19 outbreak in South Korea. Asian Journal of Communication. 2021;31(5):337-54 https://doi.org/10.1080/01292986.2021.1968447
  39. Gharib RK, Garcia-Perez A, Dibb S, Iskoujina Z. Trust and reciprocity effect on electronic word-of-mouth in online review communities. Journal of Enterprise Information Management. 2020;33(1):120-38. https://doi.org/10.1108/JEIM-03-2019-0079
  40. Soare T, Ianovici C, Gheorghe IR, Purcărea VL, Soare CM. A word-of-mouth perspective on consumers of family medicine services: a case study. Journal of Medicine and Life. 2022;15(5):655-60 https://doi.org/10.25122/jml-2022-0098 PMid:35815082 PMCid:PMC9262271
  41. Alexander JA, Hearld LR, Mittler JN, Harvey J. Patient-physician role relationships and patient activation among individuals with chronic illness. Health Serv Res. 2012;47(3 Pt 1):1201-23. https://doi.org/10.1111/j.1475-6773.2011.01354.x PMid:22098418 PMCid:PMC3423181
  42. AlMuammar SA, Noorsaeed AS, Alafif RA, Kamal YF, Daghistani GM. The Use of Internet and Social Media for Health Information and Its Consequences Among the Population in Saudi Arabia. Cureus. 2021;13(9):e18338. https://doi.org/10.7759/cureus.18338 PMid:34722089 PMCid:PMC8551798
  43. World Health Organization. Achieving well-being: a global framework for integrating well-being into public health utilizing a health promotion approach. Geneva: World Health Organization,; 2023.
  44. Ishikawa H, Kiuchi T. Health literacy and health communication. BioPsychoSocial Medicine. 2010;4(18):1-5. https://doi.org/10.1186/1751-0759-4-18 PMid:21054840 PMCid:PMC2990724
  45. Pauli G, Martin S, Greiling D. The current state of research of word-of-mouth in the health care sector. International Review on Public and Nonprofit Marketing. 2023;20(1):125-48. https://doi.org/10.1007/s12208-022-00334-6
  46. Balakrishnan V. COVID-19 and fake news dissemination among Malaysians - Motives and its sociodemographic correlates. International Journal of Disaster Risk Reduction. 2022;73:102900 https://doi.org/10.1016/j.ijdrr.2022.102900
Journal of Health Literacy

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Available Online from 04 May 2025

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