Introduction: Digital health information seeking and browsing behavior—referring to the processes involved in identifying, retrieving, and applying information related to health conditions, diseases, and self-care management—has emerged as a prevalent strategy for enhancing health-related self-care, particularly amid the growing integration of digital technologies into daily life. Consequently, understanding how users interact with health information systems is of critical importance. The present study aims to provide a quantitative and objective analysis of digital health information browsing behavior among graduate medical sciences students within the MedlinePlus bibliographic database environment. The findings are expected to serve as a valuable resource for health information system designers, digital librarians, and user interface developers seeking to create more efficient, user-friendly, and effective digital environments for health information retrieval.
Methods: This applied study employed an evaluative approach within a controlled laboratory design. The study population comprised graduate students in medical sciences, who were sampled through a multistage method. First, using cluster sampling, four universities were randomly selected from among medical universities with multiple faculties: Isfahan University of Medical Sciences, Tehran University of Medical Sciences, Shiraz University of Medical Sciences, and Mashhad University of Medical Sciences. From each selected university, 15 students were then randomly chosen through simple random sampling, yielding a total sample of 60 participants. Data collection was conducted using a triangulation approach that included screen recording, think-aloud protocol, and direct observation. The research procedure for each participant was as follows: initially, participants attended a brief training workshop to acquire preliminary and uniform familiarity with the interface and features of the MedlinePlus databaseSubsequently, each participant took part in an individual session conducted in a quiet, well-equipped room. A standardized set of instructions was read aloud to all participants to ensure uniform comprehension of the task guidelines. At this stage, participants commenced their browsing activities without any time constraints. Screen activity and audio were recorded throughout, while the researcher performed direct observations. Concurrently, participants’ thoughts were elicited using the think-aloud protocol. Users’ browsing behaviors were classified into two general categories for analysis: implicit and explicit moves. Implicit moves were interpreted as reflecting users’ cognitive processes and conceptual reasoning, whereas explicit moves comprised direct, observable interactions with system features. Quantitative data, obtained by counting implicit and explicit moves, were analyzed using descriptive statistics and correlation analysis (Spearman’s rank correlation coefficient). Between-group comparisons involving clinical and non-clinical participants were conducted using the Mann-Whitney U test.
Findings: The findings revealed a significantly higher proportion of explicit moves (86.81%) compared to implicit moves (13.12%), underscoring a dominant pattern in user browsing behavior within the MedlinePlus environment. This behavioral pattern suggests that participating users tended to explore the environment extensively before committing to a specific information path. Moreover, a moderate, positive, and statistically significant correlation was identified between users’ implicit and explicit moves (ρ = 0.649, P < 0.01). Group comparisons further indicated that non-clinical users exhibited a higher mean rank in implicit moves than their clinical counterparts, whereas no significant group difference was observed in explicit move.
Discussion & Conclusion: The findings of this study reveal an exploratory and dynamic browsing pattern among participating users, which may be attributed either to the rich informational structure of MedlinePlus or to the inherent characteristics of the assigned browsing tasks. Throughout this process, explicit and implicit moves jointly shape the cognitive and behavioral dimensions of user interaction with the information system. Moreover, the presence of a moderate, positive, and statistically significant correlation between these two types of moves suggests continuity and integration between the cognitive and behavioral layers during the search process. In other words, the more deeply a user contemplates their target concept, the greater their need to explore alternative options in order to address their cognitive gap. The observed differences between clinical and non-clinical users may be accounted for by variations in their familiarity with specialized terminology; non-clinical users, owing to their comparatively limited health literacy, inevitably engage in more intensive cognitive processing. In contrast, clinical users, drawing on their prior knowledge, demonstrated greater efficiency in information retrieval by following a more direct, goal-oriented search path. Nevertheless, no significant difference was observed between the two groups in terms of explicit moves. This finding can be interpreted from two perspectives. First, as operational actions, explicit moves are more heavily influenced by the user interface design and the physical constraints inherent in the MedlinePlus database. Second, from a methodological standpoint, it is possible that current measurement tools lack sufficient sensitivity to distinguish the nature of clicks between the two groups. Therefore, given the characteristics of the study population, generalization of the results to other digital health users should be undertaken with caution.
Originality: By focusing on the objective analysis of both implicit and explicit moves in browsing behavior, this study offers a distinct approach to investigating user interaction with health information systems and lays the groundwork for future research in this domain.