Working (out) with fitness influencers - benefits for the fitness influencer, user health, and the endorsed brand: Key factors and the role of gender and brand familiarity.

Objective: Fitness influencers have become important digital health communicators with regard to influencing consumer health behaviours, such as physical activity. We investigate how working (out) with these new communicators can generate benefits for the fitness influencer, user health, and endorsed brands. Based on the source credibility, social identity theory, and gender congruity research, this paper aims to identify the main factors that affect users' attitudes toward the fitness influencer (influencer benefit), users' exercise intentions (user health benefit) and their purchase intentions (brand benefit), considering user and influencer gender. Methods: Two studies were conducted, both with male and female influencers and users. In study 1 (n = 496), the fitness influencer endorsed an unfamiliar brand, and in study 2 (n = 529) a familiar brand was endorsed. To test the proposed models and to estimate the path coefficients, structural equation modelling was performed. Results: Key influencing factors were identified in the two studies: For attitude toward the influencer, source credibility is the most important; for exercise intention, parasocial interaction and attitude toward the behaviour are crucial; and purchase intention is largely predicted by the brand attitude. The studies revealed gender-congruent and non-congruent tendencies for female and male respondents, and different effects of unfamiliar and familiar brands. Conclusions: Working (out) with fitness influencers can improve user attitudes toward the influencer, increase users' exercise intentions, and increase brand purchase intentions, for both unfamiliar and familiar brands. Some gender congruity and some gender incongruity effects exist. The paper discusses important implications for theory and practice.

Motivate me to exercise with you: The effects of social media fitness influencers on users' intentions to engage in physical activity and the role of user gender.

Objective: Social media fitness influencers are evolving into a new digital form of health communicators whom consumers might turn to for assistance with more physical activity and exercise at home, especially in the current COVID-19 crisis. Drawing from source credibility theory, social cognitive theory, protection motivation theory and literature on physical activity, physical fitness and gender, we analyse how male and female users' evaluations of social media fitness influencers and user health-related variables impact intentions to exercise with the social media fitness influencer. Methods: Two consecutive studies using male and female YouTube fitness influencers were carried out. Structural equation modelling was conducted to test the proposed models and estimate the path coefficients. Results: Study 1 (N = 507) shows that the respective influencer's perceived trustworthiness, expertise and attractiveness are important for the influencer's evaluation, and that it is the perceived motivating power rather than the attitude toward the influencer that increases intentions to exercise for male and female users. Study 2 (N = 445) extends Study 1 and shows that physical fitness, training involvement with YouTube fitness videos and lower health increase behavioural intentions. A more negative body image also raises intentions to exercise, but only among female users. Conclusion: Social media fitness influencers who are perceived as trustworthy, as experts and as attractive, can be effective for increasing men's and women's physical activity. Perceived motivating power of the influencer emerged as a key variable that predicts intentions to exercise. User health-related variables have different effects on intentions to exercise for men and women.

Promoting advance care planning via mediated health resources: A systematic mixed studies review.

OBJECTIVE: This systematic review aims (a) to analyze the message design of mediated advance care planning (ACP) interventions targeted at adults from a social marketing and health communication perspective, (b) to identify associations between message design and ACP outcomes, and (c) to illuminate gaps in the literature and highlight needs for future research. METHODS: A systematic mixed studies review was conducted. Empirical articles on mediated ACP interventions were systematically searched by using nine scientific databases with keywords related to ACP and mediated health communication. Data were synthesized using a sequential explanatory approach. RESULTS: A total of 11,824 titles were identified, of which 36 studies were included. Interventions disseminated ACP messages via video (36%), digital channels (22%), print (19%), a combination of channels (19%), and mass media (3%). The interventions used generic (42%), targeted (33%), and tailored (25%) communication. Overall, the evidence suggests that mediated ACP resources positively impact ACP Process and Action outcomes. CONCLUSION: This study has shown that mediated ACP interventions use various contents, formats, and structures to influence patient-centered ACP outcomes. Most message design techniques were associated with positive ACP outcomes. PRACTICE IMPLICATIONS: Mediated ACP resources are a promising approach to encourage ACP among adults.

What Patients Value in Physicians: Analyzing Drivers of Patient Satisfaction Using Physician-Rating Website Data.

BACKGROUND: Customer-oriented health care management and patient satisfaction have become important for physicians to attract patients in an increasingly competitive environment. Satisfaction influences patients' choice of physician and leads to higher patient retention and higher willingness to engage in positive word of mouth. In addition, higher satisfaction has positive effects on patients' willingness to follow the advice given by the physician. In recent years, physician-rating websites (PRWs) have emerged in the health care sector and are increasingly used by patients. Patients' usage includes either posting an evaluation to provide feedback to others about their own experience with a physician or reading evaluations of other patients before choosing a physician. The emergence of PRWs offers new avenues to analyze patient satisfaction and its key drivers. PRW data enable both satisfaction analyses and implications on the level of the individual physician as well as satisfaction analyses and implications on an overall level. OBJECTIVE: This study aimed to identify linear and nonlinear effects of patients' perceived quality of physician appointment service attributes on the overall evaluation measures that are published on PRWs. METHODS: We analyzed large-scale survey data from a German PRW containing 84,680 surveys of patients rating a total of 7038 physicians on 24 service attributes and 4 overall evaluation measures. Elasticities are estimated from regression models with perceived attribute quality as explanatory variables and overall evaluation measures as dependent variables. Depending on the magnitude of the elasticity, service attributes are classified into 3 categories: attributes with diminishing, constant, or increasing returns to overall evaluation. RESULTS: The proposed approach revealed new insights into what patients value when visiting physicians and what they take for granted. Improvements in the physicians' pleasantness and friendliness have increasing returns to the publicly available overall evaluation (b=1.26). The practices' cleanliness (b=1.05) and the communication behavior of a physician during a visit (b level between .97 and 1.03) have constant returns. Indiscretion in the waiting rooms, extended waiting times, and a lack of modernity of the medical equipment (b level between .46 and .59) have the strongest diminishing returns to overall evaluation. CONCLUSIONS: The categorization of the service attributes supports physicians in identifying potential for improvements and prioritizing resource allocation to improve the publicly available overall evaluation ratings on PRWs. Thus, the study contributes to patient-centered health care management and, furthermore, promotes the utility of PRWs through large-scale data analysis.

Advance directives in Austrian intensive care units: An analysis of prevalence and barriers.

PURPOSE: To investigate the prevalence of advance directives, healthcare proxies, and legal representatives in Austrian intensive care units (ICUs), and to explore barriers faced by adults engaged in the contemplation and documentation phase of the advance care planning process. METHODS: Two studies were conducted: (1) A 4-week multicenter study covering seven Austrian ICUs. A retrospective chart review of 475 patients who presented to the ICUs between 1 January 2019 and 31 January 2019 was conducted. (2) An interview and focus group study with 12 semi-structured expert interviews and three focus groups with 21 adults was performed to gain insights into potential barriers faced by Austrian adults planning medical decisions in advance. RESULTS: Of the 475 ICU patients, 3 (0.6%) had an advance directive, 4 (0.8%) had a healthcare proxy, and 7 (1.5%) had a legal guardian. Despite the low prevalence rates, patients and relatives reacted positively to the question of whether they had an advance directive. Patients older than 55 years and patients with children reacted significantly more positively than younger patients and patients without children. The interviews and focus groups revealed important barriers that prevent adults in Austria from considering planning in advance for potentially critical health states. CONCLUSION: The studies show low prevalence rates of healthcare documents in Austrian ICUs. However, when patients were asked about an advance directive, reactions indicated positive attitudes. The gap between positive attitudes and actual document completion can be explained by multiple barriers that exist for adults in Austria when it comes to planning for potential future incapacity.

Your Personal Motivator is with You: A Systematic Review of Mobile Phone Applications Aiming at Increasing Physical Activity.

BACKGROUND: Literature shows mixed evidence about the power of mobile phone applications to foster physical activity. A systematic integration that offers insights into which mobile phone application techniques can or cannot foster physical activity is lacking, as is a theoretical integration of current research. OBJECTIVES: We performed a systematic review guided by a theoretical framework focusing on effects that certain mobile phone application techniques have on physical activity, to improve our understanding of what techniques are more or less effective. METHODS: We identified articles by searching EBSCO Business Source Complete, Science Direct, PsycINFO, Springer, PLoS ONE, Taylor and Francis, IEEE, Social Science Citation Index, Science Citation Index Expanded, PUBMED, MEDLINE, and Google Scholar. We considered articles if (1) they referred to the use of mobile phone applications to promote physical activity; (2) their methodological approach allowed one to derive appropriate results (e.g., intervention-based approach, observational study); (3) they were published in peer-reviewed journals or conference proceedings; and (4) they were written in English. The literature search resulted in 41 usable studies. Meta-synthesis and vote counting were applied to analyze these studies. RESULTS: Based on the ratio of supportive versus non-supportive evidence in both the qualitative and the quantitative studies, we propose the following descending rank order for the effectiveness of application techniques to foster physical activity. This is tentative in nature because the current overall small body of literature made coming to definite conclusions difficult: (1) feedback, (2) goal setting and its sub-forms, (3) competition, social sharing with familiar users in both segregated and social network groups, and (4) social sharing with strangers in segregated groups, reward, and social sharing with strangers in social network groups. Rewards in particular provided mixed results, and social sharing with strangers in segregated and social network groups seemed rather ineffective but may work under special conditions that need to be identified in additional research. One limitation of our study was that our results are mostly derived from qualitative studies, since quantitative studies are underrepresented in the field. CONCLUSION: Several mobile phone application techniques were identified that have the potential to foster physical activity, whereas others were identified that are unlikely to increase physical activity. Major avenues for future research include more theoretical development and more quantitative studies, among others.

The use of advertising appeals in breast cancer detection messages: a web content analysis.

We explored the use of different advertising appeals in breast cancer detection messages. We analyzed the extent to which emotional appeals were applied in advertisements that promoted two forms of breast cancer detection behaviors: breast self-examination (BSE) and mammographic screening. Findings of a content analysis of 456 breast cancer-related advertisements gathered in February 2016 indicated that textual fear appeals, humor appeals and erotic appeals were more likely to be featured in BSE-promoting advertisements than in breast cancer-related advertisements with other message purposes. While shame-guilt appeals were more likely to be used in mammography-promoting messages, humor and erotic appeals were less likely to be applied. Regarding hybrid message appeals, combinations of humor appeals with erotic, fear and shame-guilt appeals, as well as combined erotic-fear appeals were found more in BSE-promotion messages. Mammography-promoting messages made less use of hybrid messages with a humorous touch as compared to breast cancer advertisements with other message purposes. The results are in contrast to research findings on the effectiveness of message appeals and thus allow to some extent the evaluation of whether scientific findings on the effectiveness of message appeals are reflected in the current advertising practice.

The same video game in 2D, 3D or virtual reality - How does technology impact game evaluation and brand placements?

Video game technology is changing from 2D to 3D and virtual reality (VR) graphics. In this research, we analyze how an identical video game that is either played in a 2D, stereoscopic 3D or Head-Mounted-Display (HMD) VR version is experienced by the players, and how brands that are placed in the video game are affected. The game related variables, which are analyzed, are presence, attitude towards the video game and arousal while playing the video game. Brand placement related variables are attitude towards the placed brands and memory (recall and recognition) for the placed brands. 237 players took part in the main study and played a jump'n'run game consisting of three levels. Results indicate that presence was higher in the HMD VR than in the stereoscopic 3D than in the 2D video game, but neither arousal nor attitude towards the video game differed. Memory for the placed brands was lower in the HMD VR than in the stereoscopic 3D than in the 2D video game, whereas attitudes towards the brands were not affected. A post hoc study (n = 53) shows that cognitive load was highest in the VR game, and lowest in the 3D game. Subjects reported higher levels of dizziness and motion-sickness in the VR game than in the 3D and in the 2D game. Limitations are addressed and implications for researchers, marketers and video game developers are outlined.

What Predicts Patients' Willingness to Undergo Online Treatment and Pay for Online Treatment? Results from a Web-Based Survey to Investigate the Changing Patient-Physician Relationship.

BACKGROUND: Substantial research has focused on patients' health information-seeking behavior on the Internet, but little is known about the variables that may predict patients' willingness to undergo online treatment and willingness to pay additionally for online treatment. OBJECTIVE: This study analyzed sociodemographic variables, psychosocial variables, and variables of Internet usage to predict willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the general practitioner (GP). METHODS: An online survey of 1006 randomly selected German patients was conducted. The sample was drawn from an e-panel maintained by GfK HealthCare. Missing values were imputed; 958 usable questionnaires were analyzed. Variables with multi-item measurement were factor analyzed. Willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the GP were predicted using 2 multiple regression models. RESULTS: Exploratory factor analyses revealed that the disposition of patients' personality to engage in information-searching behavior on the Internet was unidimensional. Exploratory factor analysis with the variables measuring the motives for Internet usage led to 2 separate factors: perceived usefulness (PU) of the Internet for health-related information searching and social motives for information searching on the Internet. Sociodemographic variables did not serve as significant predictors for willingness to undergo online treatment offered by the GP, whereas PU (B=.092, P=.08), willingness to communicate with the GP more often in the future (B=.495, P<.001), health-related information-seeking personality (B=.369, P<.001), actual use of online communication with the GP (B=.198, P<.001), and social motive (B=.178, P=.002) were significant predictors. Age, gender, satisfaction with the GP, social motive, and trust in the GP had no significant impact on the willingness to pay additionally for online treatment, but it was predicted by health-related information-seeking personality (B=.127, P=.07), PU (B=-.098, P=.09), willingness to undergo online treatment (B=.391, P<.001), actual use of online communication with the GP (B=.192, P=.001), highest education level (B=.178, P<.001), monthly household net income (B=.115, P=.01), and willingness to communicate with the GP online more often in the future (B=.076, P=.03). CONCLUSIONS: Age, gender, and trust in the GP were not significant predictors for either willingness to undergo online treatment or to pay additionally for online treatment. Willingness to undergo online treatment was partly determined by the actual use of online communication with the GP, willingness to communicate online with the GP, health information-seeking personality, and social motivation for such behavior. Willingness to pay extra for online treatment was influenced by the monthly household net income category and education level. The results of this study are useful for online health care providers and physicians who are considering offering online treatments as a viable number of patients would appreciate the possibility of undergoing an online treatment offered by their GP.

Benefits and stressors - Perceived effects of ICT use on employee health and work stress: An exploratory study from Austria and Hong Kong.

Stress has become a mass phenomenon in the modern workplace. The use of information and communication technologies is beginning to receive greater attention in the context of occupational stress. An exploratory qualitative study was conducted to examine both stressors and benefits resulting from technologies among practitioners in the advertising, public relations, and journalism industry in Hong Kong and Austria. Results suggest that technologies allow instant availability, which facilitates communication processes as well as information exchange. Notably, modern technologies enable employees to organize their work with greater temporal and spatial flexibility, thus creating an opportunity for better balancing work and private life. However, evolving technologies have come with a cost; the pressure to be constantly available via technologies constitutes a major source of stress, increasing the risk of experiencing prolonged work stress and its adverse consequences on employee health and well-being, such as a burnout. Furthermore, findings suggest that availability pressure may be attributed to an inner obligation rather than to an organizational expectation. Hence, making employees aware of their connectivity behaviour may help to diminish the experience of technology-induced work stress and improve and maintain employees' health and well-being in the long term. Practical implications, limitations, and future research directions are provided.

Gender Differences in Searching for Health Information on the Internet and the Virtual Patient-Physician Relationship in Germany: Exploratory Results on How Men and Women Differ and Why.

BACKGROUND: Many studies have shown that women use the Internet more often for health-related information searches than men, but we have limited knowledge about the underlying reasons. We also do not know whether and how women and men differ in their current use of the Internet for communicating with their general practitioner (GP) and in their future intention to do so (virtual patient-physician relationship). OBJECTIVE: This study investigates (1) gender differences in health-related information search behavior by exploring underlying emotional, motivational, attitudinal as well as cognitive variables, situational involvement, and normative influences, and different personal involvement regarding health-related information searching and (2) gender differences in the virtual patient-physician relationship. METHODS: Gender differences were analyzed based on an empirical online survey of 1006 randomly selected German patients. The sample was drawn from an e-panel maintained by GfK HealthCare. A total of 958 usable questionnaires were analyzed. Principal component analyses were carried out for some variables. Differences between men (517/958) and women (441/958) were analyzed using t tests and Kendall's tau-b tests. The survey instrument was guided by several research questions and was based on existing literature. RESULTS: Women were more engaged in using the Internet for health-related information searching. Gender differences were found for the frequency of usage of various Internet channels for health-related information searches. Women used the Internet for health-related information searches to a higher degree for social motives and enjoyment and they judged the usability of the Internet medium and of the information gained by health information searches higher than men did. Women had a more positive attitude toward Web 2.0 than men did, but perceived themselves as less digitally competent. Women had a higher health and nutrition awareness and a greater reluctance to make use of medical support, as well as a higher personal disposition of being well-informed as a patient. Men may be more open toward the virtual patient-physician relationship. CONCLUSIONS: Women have a stronger social motive for and experience greater enjoyment in health-related information searches, explained by social role interpretations, suggesting these needs should be met when offering health-related information on the Internet. This may be interesting for governmental bodies as well as for the insurance and the pharmaceutical industries. Furthermore, women may be more easily convinced by health awareness campaigns and are, therefore, the primary target group for them. Men are more open to engaging in a virtual relationship with the GP; therefore, they could be the primary target group for additional online services offered by GPs. There were several areas for GPs to reinforce the virtual patient-physician relationship: the fixing of personal appointments, referral to other doctors, writing prescriptions, and discussions of normal test results and doctor's notes/certificates of health.

What explains usage of mobile physician-rating apps? Results from a web-based questionnaire.

BACKGROUND: Consumers are increasingly accessing health-related information via mobile devices. Recently, several apps to rate and locate physicians have been released in the United States and Germany. However, knowledge about what kinds of variables explain usage of mobile physician-rating apps is still lacking. OBJECTIVE: This study analyzes factors influencing the adoption of and willingness to pay for mobile physician-rating apps. A structural equation model was developed based on the Technology Acceptance Model and the literature on health-related information searches and usage of mobile apps. Relationships in the model were analyzed for moderating effects of physician-rating website (PRW) usage. METHODS: A total of 1006 randomly selected German patients who had visited a general practitioner at least once in the 3 months before the beginning of the survey were randomly selected and surveyed. A total of 958 usable questionnaires were analyzed by partial least squares path modeling and moderator analyses. RESULTS: The suggested model yielded a high model fit. We found that perceived ease of use (PEOU) of the Internet to gain health-related information, the sociodemographic variables age and gender, and the psychographic variables digital literacy, feelings about the Internet and other Web-based applications in general, patients' value of health-related knowledgeability, as well as the information-seeking behavior variables regarding the amount of daily private Internet use for health-related information, frequency of using apps for health-related information in the past, and attitude toward PRWs significantly affected the adoption of mobile physician-rating apps. The sociodemographic variable age, but not gender, and the psychographic variables feelings about the Internet and other Web-based applications in general and patients' value of health-related knowledgeability, but not digital literacy, were significant predictors of willingness to pay. Frequency of using apps for health-related information in the past and attitude toward PRWs, but not the amount of daily Internet use for health-related information, were significant predictors of willingness to pay. The perceived usefulness of the Internet to gain health-related information and the amount of daily Internet use in general did not have any significant effect on both of the endogenous variables. The moderation analysis with the group comparisons for users and nonusers of PRWs revealed that the attitude toward PRWs had significantly more impact on the adoption and willingness to pay for mobile physician-rating apps in the nonuser group. CONCLUSIONS: Important variables that contribute to the adoption of a mobile physician-rating app and the willingness to pay for it were identified. The results of this study are important for researchers because they can provide important insights about the variables that influence the acceptance of apps that allow for ratings of physicians. They are also useful for creators of mobile physician-rating apps because they can help tailor mobile physician-rating apps to the consumers' characteristics and needs.

Who uses physician-rating websites? Differences in sociodemographic variables, psychographic variables, and health status of users and nonusers of physician-rating websites.

BACKGROUND: The number of physician-rating websites (PRWs) is rising rapidly, but usage is still poor. So far, there has been little discussion about what kind of variables influence usage of PRWs. OBJECTIVE: We focused on sociodemographic variables, psychographic variables, and health status of PRW users and nonusers. METHODS: An online survey of 1006 randomly selected German patients was conducted in September 2012. We analyzed the patients' knowledge and use of online PRWs. We also analyzed the impact of sociodemographic variables (gender, age, and education), psychographic variables (eg, feelings toward the Internet, digital literacy), and health status on use or nonuse as well as the judgment of and behavior intentions toward PRWs. The survey instrument was based on existing literature and was guided by several research questions. RESULTS: A total of 29.3% (289/986) of the sample knew of a PRW and 26.1% (257/986) had already used a PRW. Younger people were more prone than older ones to use PRWs (t967=2.27, P=.02). Women used them more than men (χ(2) 1=9.4, P=.002), the more highly educated more than less educated people (χ(2) 4=19.7, P=.001), and people with chronic diseases more than people without (χ(2) 1=5.6, P=.02). No differences were found between users and nonusers in their daily private Internet use and in their use of the Internet for health-related information. Users had more positive feelings about the Internet and other Web-based applications in general (t489=3.07, P=.002) than nonusers, and they had higher digital literacy (t520=4.20, P<.001). Users ascribed higher usefulness to PRWs than nonusers (t612=11.61, P<.001) and users trusted information on PRWs to a greater degree than nonusers (t559=11.48, P<.001). Users were also more likely to rate a physician on a PRW in the future (t367=7.63, P<.001) and to use a PRW in the future (t619=15.01, P<.001). The results of 2 binary logistic regression analyses demonstrated that sociodemographic variables (gender, age, education) and health status alone did not predict whether persons were prone to use PRWs or not. Adding psychographic variables and information-seeking behavior variables to the binary logistic regression analyses led to a satisfying fit of the model and revealed that higher education, poorer health status, higher digital literacy (at the 10% level of significance), lower importance of family and pharmacist for health-related information, higher trust in information on PRWs, and higher appraisal of usefulness of PRWs served as significant predictors for usage of PRWs. CONCLUSIONS: Sociodemographic variables alone do not sufficiently predict use or nonuse of PRWs; specific psychographic variables and health status need to be taken into account. The results can help designers of PRWs to better tailor their product to specific target groups, which may increase use of PRWs in the future.

Physicians' motives for professional internet use and differences in attitudes toward the internet-informed patient, physician-patient communication, and prescribing behavior.

BACKGROUND: Physicians have differing motives for using the Internet and Internet-related services in their professional work. These motives may affect their evaluation of patients who bring with them health-related information from the Internet. Differing motives may also affect physician-patient communication and subsequent prescribing behavior. OBJECTIVES: to segment physicians into types based on their motives for using the internet in connection with professional activities and to analyze how those segments differ in their attitudes in three areas: toward patients who bring along Internet-sourced information; in their own subsequent prescribing behavior; and in their attitudes toward using the Internet to communicate with patients in future. METHODS: We surveyed 287 German physicians online from three medical fields. To assess physicians' motives for using the Internet for their professional activities, we asked them to rate their level of agreement with statements on a 7-point scale. Motive statements were reduced to motive dimensions using principal component analysis, and 2-step cluster analysis based on motive dimensions identified different segments of physicians. Several statements assessed agreement or disagreement on a 7-point scale physicians' attitudes toward patients' bringing Internet information to the consultation and their own subsequent prescribing behavior. Further, we asked physicians to indicate on a 7-point scale their valuation of the Internet for physician-patient communication in the future. Data were then subjected to variance and contingency analyses. RESULTS: we identified three motive dimensions for internet use: (1) being on the cutting edge and for self-expression (Cronbach alpha = .88), (2) efficiency and effectiveness (alpha = .79), and (3) diversity and convenience (alpha = .71). These three factors accounted for 71.4% of the variance. Based on physicians' motives for using the Internet, four types of physician Internet user were identified: (1) the Internet Advocate (2), Efficiency-Oriented, (3) Internet Critic, and (4) Driven Self-expressionist. Groups differed significantly concerning (1) their attitude toward informed patients in general (F 1234 = 9.215, P < .001), (2) perceived improvement in the physician-patient relationship Internet information brings (F 1234 = 5.386, P < .001), (3) perceived accuracy of information the patient brings (F 1234 = 3.658, P = .01), and (4) perceived amount of time needed to devote to an Internet-informed patient (F 1234 = 3.356, P = .02). Physician segments did not differ significantly in reported prescribing behavior (F 1234 = 1.910, P = .13). However, attitudes toward using the Internet to communicate with patients in future differed significantly (F 1234 = 23.242, P < .001). CONCLUSIONS: Based on self-reporting by German physicians of their motives for professional Internet use, we identified four types of Internet users who differ significantly in their attitude toward patients who bring along Internet information and their attitudes toward using the Internet to communicate with patients in future.