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Online health information seeking, verification behaviour, and misinformation perceptions among adults with chronic disease in Saudi Arabia: a structural equation modelling study
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DOI：10.1186/s12889-026-28721-2.png)
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Abstract
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Adults living with chronic disease increasingly depend on online sources for day-to-day self-management, yet digital environments expose them to health misinformation of variable credibility. Prior research has largely examined information seeking, verification, or misinformation exposure in isolation, leaving the behavioural mechanisms that connect them poorly understood. Drawing on dual-process accounts of information processing, this study examined how online health information seeking (HIS), verification behaviour (VER), and misinformation-related perceptions (MIS) interrelate among adults with chronic disease and tested whether verification mediates the association between information engagement and misinformation awareness. A cross-sectional online survey was completed by 740 adults with self-reported chronic disease, recruited through messaging platforms and patient support organisations in Saudi Arabia. Validated five-point Likert-scale items measured HIS, VER, and MIS. Data were analysed using descriptive statistics, visual analytics, and structural equation modelling (SEM) in R (lavaan); construct reliability and convergent validity were assessed via composite reliability and average variance extracted. Descriptive analyses were based on all 740 respondents (item-level n = 724–740, as most items were optional), whereas the structural model used the 680 cases with complete data on all modelled items. Participants reported frequent online health information seeking and widespread use of verification strategies, alongside high awareness of misleading social media content. On re-estimation using the final verified dataset, global model fit was below conventional thresholds (CFI = 0.874; TLI = 0.844; RMSEA = 0.153; SRMR = 0.090), so the structural estimates are interpreted descriptively and with caution. HIS was strongly and positively associated with VER (β = 0.82, P < .001). VER was positively associated with MIS (β = 0.73, P < .001), a pattern that may reflect heightened evaluative awareness of misleading content rather than passive susceptibility, although this interpretation remains tentative given the cross-sectional design and the high correlations among constructs. The direct HIS→MIS path was non-significant (β = 0.09, P = .21), indicating that information engagement related to misinformation perceptions primarily through verification. Findings are consistent with a behaviourally integrated, mediated model in which online information seeking is associated with greater verification, and verification, as a form of systematic evaluative processing, is associated with greater awareness of misinformation rather than vulnerability to it; because the data are cross-sectional and the constructs overlap empirically, these pathways describe associations rather than demonstrated causal effects. By modelling these constructs simultaneously, the study moves beyond descriptive accounts and positions chronic disease patients as active appraisers of digital health information. Interventions that reinforce verification skills and embed credibility cues within commonly used platforms may strengthen safe digital health engagement.
Keywords:
Online health information seeking
Chronic disease self-management
Health information verification
Health misinformation
Structural equation modelling
Digital health literacy
Patient information behaviour
Saudi Arabia
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