Determinants of trust in a live chat service for familial cancer risk: Findings from a qualitative triangulation study in Germany (Preprint)

Abstract

Trust is of great importance in situations marked by risk and uncertainty. A suspected or confirmed familial cancer risk is associated with great fear and uncertainty. Here, seeking for online health information can be a coping strategy for patients, relatives and those suspecting an elevated risk. However, there is a myriad of online cancer information of variable quality and trust has shown to be key to health information seeking. As trust is multidimensional and highly context-dependent, determinants of trust must be explored in their specific context and, in online environments, in relation to their application. While online live chats are regularly employed for commercial purposes, their application for personalized health information regarding complex diseases such as familial cancer risk remains underexplored.

As trust is subjective, it can be enhanced if it aligns with the trustor’s expectations. To gain a comprehensive picture of trust formation in a cancer-related live chat service, this study investigated three dimensions of trust and their respective determinants based on a model og trust in online health information.

This qualitative study triangulated the perspectives of three different samples in interviews and focus group discussions to explore three dimensions of trust – trustor, trustee and application – and their determinants for a new live chat service for familial cancer risk to be implemented at the German Cancer Information Service (CIS).

Results indicate that having a personal experience with familial cancer risk is key to potentially trusting information in the live chat service. The live chat might also be particularly valuable for people from minority groups who experience discrimination in doctor-patient interactions. The trustee's expectations in the exchange are that the responding trustor is a human being (and not a chatbot), who demonstrates empathy and good communication skills. Demonstrating institutional authority, a professional design and ensuring data security are application-related determinants of trust.

Trust in a live chat for cancer information is a dynamic, triangular interplay between different dimensions and determinants of trust. Weighing determinants against each other is not possible, rather our study found that trust develops and can be fostered by integrating trust-promoting elements in the live chat (e.g., biographies of the human medical experts).