**1. Introduction**

The COVID-19 pandemic, caused by the novel Sars-CoV-2 coronavirus, has caused the death of millions of people and disrupted daily life worldwide. During this pandemic, individuals were restricted from going outside, and physical activities were reduced as a result of its impact. Consequently, people gathered, exchanged information, and entertained themselves via the internet, with online health information becoming an alternative to personal visits to physical hospitals and medical centers. On 19 May 2021, Taiwan's Ministry of Education announced that students at all levels would stop attending schools, fully initiating online instruction. The impact of campus closures and significant social changes brought many challenges to higher education, affecting personal internet use. The COVID-19 pandemic brought into renewed focus the health of students in higher education, which already necessitated concern [1]. In Taiwan, the internet is the source of health-related information for 100% of undergraduate students who avail it on a frequent basis [2]. When these students encounter health-related problems, they often resort to the internet to obtain information as a temporary solution [3].

Online platforms have the potential to provide individuals with useful information, increase their engagement, and potentially revolutionize the patient–physician relationship [4]. Information seeking has become a focus of health communication scholarship, since individuals can now use a variety of platforms, such as the television, newspapers, the internet, and other interpersonal communication channels, to gain knowledge [5]. Chen and Lee [6] noted that people often have limited skills related to retrieving and evaluating

**Citation:** Hsu, W.-C. Undergraduate Students' Online Health Information-Seeking Behavior during the COVID-19 Pandemic. *Int. J. Environ. Res. Public Health* **2021**, *18*, 13250. https://doi.org/10.3390/ ijerph182413250

Academic Editors: Paul B. Tchounwou, Paolo Roma, Merylin Monaro and Cristina Mazza

Received: 28 October 2021 Accepted: 13 December 2021 Published: 16 December 2021

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**Copyright:** © 2021 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

the vast amount of information available from a variety of online sources with varying quality. This overwhelming availability of online health information highlights the importance of understanding the status and key influencing factors of its use among individuals.

Health information is defined as information that can assist individuals in promoting their health, making health-related decisions, and participating in the healthcare system [7]. Information seeking can be unintentional, passive, or active [8] and is often purposeful, with individuals seeking information to meet a personal need or goal [9]. Informationseeking behavior is the action of searching for and using information in any way, following an individual's need. In particular, it relates to the behavior arising from an interaction with the information source when one needs information; it can range from passive attention to passive searching, active searching, and ongoing searches, all of which fall within the scope of information-seeking behavior [9]. Online health information-seeking behavior is dominated by active information seeking and passive information acquisition [7]. Health information-seeking behavior is a type of personal health promotion in which individuals obtain expertise from various sources, such as doctors, to inform their decisions, improve their food and nutrition intake, relieve stress, and reduce drug abuse [5]. In sum, online health information-seeking behavior involves individuals' retrieval of health information from the internet, which can be actively or passively motivated, for the purpose of obtaining knowledge for personal health promotion and facilitating decision making.

Regarding health information retrieval and health promotion theories, the social cognitive theory is one of the most widely used theoretical frameworks [10]. Bandura's social cognitive theory provides a structure for interpreting the relevant results of individuals after retrieving information [11,12]. For example, how much confidence an individual has in finding quality health information, i.e., their self-efficacy in searching, is also related to the expected results after retrieval. Self-efficacy can be a powerful predictor of expected results regarding an individual's online health information-seeking behavior [13]. The risk information seeking and processing model (RISP) is one of the representative theoretical models explaining online information seeking. It emphasizes that the behavior of individuals to retrieve online information is triggered by insufficient cognitive data (termed as information insufficiency hereafter); according to the model, a lack of information is the main factor directly driving information seeking, alongside other incidental social and psychological factors, such as emotional response (worry, anxiety) and subjective criticism of information. The RISP model thus provides a framework to explain the key influencing factors that individuals use to seek and process relevant risk information in a more systematic or deliberate manner. Brown, Skelly, and Chew-Graham [14] proposed a model, pointing out that individuals' online health information retrieval is affected by their previous experience, health beliefs, and other personal background factors.

Research on health information-seeking behavior in Taiwan remains in its infancy. Previous studies have focused on the content of health information texts [15,16], the effect of health information on readers' intention to use it [17], health information-seeking experiences [17,18], the relationship between online information seeking and cognitive factors [19], and how postsearch emotions affect social cognitive factors and perceptions, indirectly shaping attitudes and behavior [13]. Information literacy, one of the core competencies of eHealth literacy, is an individual's ability to understand how to effectively search for, organize, and use information, for example, by retrieving relevant information using a keyword [20].

Health-related issues, such as health literacy, are more frequently discussed in the context of adult health decision making and health behavior. Although adolescents need to increase their sense of responsibility for maintaining their own health, less research has been conducted among this age group [21]. The present study, therefore, investigated the online health information-seeking behaviors of undergraduate students, using common health problems as a guide. Here, online health information-seeking behavior was defined as individuals retrieving health information through the internet. The specific behavioral items observed were "keyword selection", "information browsing", and "information sources"; suggestions were then devised for a skills development program to shape undergraduate students' online health information-seeking behaviors based on the findings. The academic contributions of this study could enrich our knowledge and theoretical scope of online health information-seeking behavior issues, highlighting their value for students in the COVID-19 era.
