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How health-conscious consumers want to live in a healthy world, health & wellness.

All around the world, consumers are re-inventing how they approach health threats and wellness-related decisions. Our  Global Health and Wellness report explores consumer sentiment across 17 diverse global markets to help understand the global state of health, wellness, and well-being. It showcases a universal hierarchy of needs that empowers a deeper understanding of how consumers are currently prioritizing their health and wellness needs.     

This hierarchy, applied to the current state of health and wellness, brings to light a total view of consumer health needs. It highlights unique differences in the innate order to which consumers are prioritizing their health needs: those that are protective, preservation-focused, aspirational, evolving, and altruistic in nature.    

Altruistic needs delve into selfless consumption that supports environmental, ethical, humanitarian or other philanthropic causes. This article explores the specific causes, product claims and exemplar brands that serve health-minded consumers who strive to live in a healthy world.

Am I helping the health of the planet & those around me?

67% of global consumers say that environmental health and how their choices impact the planet is important to them

of surveyed global consumers agree that environmental issues are having an adverse impact on their current and future health

of surveyed global consumers are more likely to buy products with sustainable credentials than 2 years ago

of surveyed global consumers are willing to pay more for products that support communities and vulnerable groups

Source: NielsenIQ Global Health & Wellness /study of 17 markets, September 2021

Globally unified through the impact of living alongside COVID-19, many consumers today feel awakened to how their individual purchase decisions and experiences can collectively affect us all. The realities of air pollution, supply chain disruptions and how supporting local origin can be good for the individual, their local community and the planet are just a few ways in which pandemic living has heightened attention around altruistic health and wellness needs.

From environmental challenges, to equal access to healthcare for all and protecting our most vulnerable, there are many ways in which consumers are prioritizing the idea of a healthy world, in addition to their own health.

Global measures of consumer sentiment indicate that while many prioritize altruistic needs less so than other needs, there is considerable willingness to pay more for products with certain altruistic attributes or features. For example, 72% of surveyed respondents around the world say they would be willing to pay a premium for products that claim to be sustainable – where, 52% would be willing to pay a little bit more, and 20% of global consumers would be willing to pay a lot more for sustainable products.

Mainstream values that produce a healthy world

The concept of altruistic health and wellness is no longer in its infancy. For many consumers, their baseline expectations are for products to have clean, simple and sustainable ingredients. This is driven by heightened consumer awareness of how their individual product consumption ladders towards living in a healthy world. U.S. measures of consumer searches and retail sales exemplify just how mainstream altruistic needs have become. There has been strong, double-digit growth in the number of searches for vegan and cruelty free products, meanwhile, the swift pace of sales among clean ingredients (complexly defined by NielsenIQ, but summarized as being free from parabens, sulfates, phthalates, artificial colors, artificial fragrances and 600+ other ingredients) has outpaced sales growth of the overall beauty and personal care category.

growth in searches for ‘vegan’

growth in searches for ‘cruelty free’

Source: Consumer Searches on Amazon from Oct. 2019 – Dec. 2020

Beyond the scope of clean ingredients, there are many other pockets of growth within the sustainable product umbrella. From products backed by socially responsible organizations (+27% vs. 2019), to those that are manufactured with animal welfare in mind (+24% vs. 2019), there are many examples where products have aligned to causes with growing social gravity.

• How consumers arm themselves in the fight against health threats
• How consumers approach physical & mental well-being in 2021
• How consumers aspire to live healthy lives in 2021
• The changing face of global consumer health and wellness

All-in on clean label

Strong demand and continued growth have been constants in the world of clean label products. But interestingly enough, the leading “clean” brands today represent a mix of both old favorites and emerging up and comers. What unites these leaders is the common mission of producing products for healthy consumers who are striving to live in a healthy world.

Notably, Shea Moisture hair care products and Dr Bronners soaps both saw strong double-digit U.S. sales growth of 20% over the past year, likely driven by their long-term commitment to clean and sustainable beauty.

Some of the smaller brands that have made a splash include B.tan sunless tanner, and Sky organics personal care products, who have won with their commitment to clean ingredients without sacrificing performance.

Growth in clean for established brands as well as new

Shea moisture hair care $11.2MM, +20.8%

We strive to be sulfate free, paraben free and more, whenever possible. Tested on our family for four generations. Never on animals.

B. Tan suncare $2.8MM, +50.1%

We love animals, so we don’t test on them. And we love your bod so we keep all the nasties out of our products.

Dr. Bronners bath & shower $105MM, +19.9%

Only the purest organic and fair trade ingredients—most products vegan and certified to the same organic standards as food!

Sky organics HBL $3.8MM, +39.8%

Ours is a family deeply connected to nature and exploration, seeking travel and new experiences, always learning and engaged.

Source: NielsenIQ Retail Measurement Services, Product Insider, powered by Label Insight, Total US xAOC L52W ending 5/22/21; Beauty & Personal Care

Get ahead of the sustainability curve

While sustainability in and of itself is not new to the consumer packaged goods sector, the ways in which products are evolving to embody sustainable behaviors is constantly changing.

Take for example B.O.B. (Bars Over Bottles) a Brazilian beauty bar brand which touts water-less, plastic and chemical-free formulations that aim to reduce waste and preserve the world’s rivers and oceans. Low-waste products are commanding a swiftly growing spotlight with the U.S. haircare category as well. In fact, shampoo and conditioner bars, were the 9th most-searched hair care trend in early 2021 and offer a convenient and eco-friendly alternative to traditional bottled alternatives.

Similarly in Asia, Hong Kong skin care brand, Mono, has embodied a low-waste mentality of their own. Purchases include an empty bottle and soluble tablet that customers are instructed to combine with water in order to use. Leaving consumers to incorporate water to the product themselves results in a world of economical and environmental savings: fewer trucks and less packaging…even the wrapping of the product tablet is 100% recyclable. 

Interest in low-waste hair care is growing

Shampoo and conditioner bars were the #9 most searched hair care trend in early 2021 with 135,000+ quarterly searches on Amazon alone.

+627% Plastic free hair care

+182% Zero waste hair care

+71% Refillable hair care

Source: Label Insight consumer search data from Amazon, Target & Walmart. April 2020-March 2021

Take a deeper look into the global consumer health and wellness revolution

Understanding how consumers’ altruistic health needs are being met is only part of the story. The opportunity for companies looking to meet and exceed the growing expectations of wellness-minded, conscious consumers is to figure out where your brand fits and sits along the entire hierarchy of health and wellness needs. Our  Global Health and Wellness report  takes a deep dive into how consumer needs have been reshaped around the world, what is trending, and what the budding opportunities are across the new, broadened spectrum of global well-being. 

Stay one step ahead by staying up to date.

Don’t miss out on latest insights, offers and opportunities by NielsenIQ.

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The 5S’s of Consumer Health: A Framework and Curation of JCR Articles on Health and Medical Decision-Making

In this curation, we review many articles published in the Journal of Consumer Research ( JCR ) that focus on a spectrum of health and medical decisions, while highlighting five ( Bolton et al. 2008 Botti, Orfali, and Iyengar 2009 ; Briley, Rudd, and Aaker 2017 ; Longoni, Bonezzi, and Morewedge 2019 ; Moorman and Matulich 1993 ). We define consumer health and medical decisions broadly, as those relating to the prevention (e.g., minimizing stress, moderating alcohol consumption), diagnosis (e.g., utilizing health professionals for checkups), remedy and improvement (e.g., taking medication to cure an infection), and maintenance (e.g., monitoring dietary intake) of consumer health ( Moorman and Matulich 1993 ). We build on these articles to propose a new 5S (Self, Social, Solution, Service provider, Societal/Situational) framework to explain holistic drivers underlying consumers’ health and medical decisions ( figure 1 ). We hope that researchers will find this conceptual framework useful in structuring the existing consumer research literature on health. Furthermore, the 5S framework provides a clear set of four key directions that future researchers will find worthwhile in undertaking research on health and medical decision-making — either by delving deeper into the 5Ss or by going bigger and broader beyond the scope of past research.

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The goods on consumer behavior

Research by consumer psychologists aims to promote consumers’ well-being in sustainability, health, and money management

Vol. 52 No. 4

• Applied Psychology
• Marketing and Advertising

People’s decisions about how to spend their money can have a huge impact on their own lives and on the planet. Credit card debt, climate change, plastic pollution, dietary choices—all these and more, to some extent, depend on companies’ decisions about what to sell and consumers’ decisions about what to buy.

That’s why some consumer psychologists and researchers in related fields, like marketing and business, are interested in tackling these social issues through the lens of consumerism. Consumer researchers are working to understand how and why consumers make beneficial choices in areas including sustainability, health, and financial well-being. They’re also studying how to convince companies of the value of improving their supply chains or offering customers healthier, more responsible choices.

“Good, responsible scholars are trying to think about not only what is good for individuals but also what is good for society,” said Lynn Kahle, PhD, a consumer psychologist and director of the sports marketing program at Pace University in New York City.

Sustainable consumption

One big challenge facing society is switching over to a more ecologically sustainable way of life. Making sustainable choices can be a tough sell for consumers, said Katherine White, PhD, a consumer psychologist at the Sauder School of Business at the University of British Columbia in Canada. “It’s this really interesting trade-off between some kind of cost to the self in order to do something for others,” White said. (A trade-off not dissimilar to many of the public health interventions enacted during the COVID-19 pandemic.) The potential benefits of individual sustainable behaviors—recycling, choosing reusable goods, installing solar panels, eating less meat—are fuzzy and in the future, White said, and the status quo is largely set up to enable less-sustainable choices. But to tackle problems like climate change and environmental degradation, both systems and individuals will have to change, she said. “It’s probably the most challenging behavior-change question of our time.”

When consumer psychologists first began studying sustainable behavior in the 1970s, their focus was largely on how to identify consumers who were already prone to go green, said Remi Trudel, PhD, an associate professor of marketing at Boston University’s Questrom School of Business. Over time, though, researchers have begun to focus on how to influence more people. “The biggest question is, how do we nudge people into behaving more sustainably?” Trudel said.

In a 2019 review, White and her colleagues organized research on the topic into a framework they call SHIFT ( Journal of Marketing , Vol. 83, No. 3, 2019 ). SHIFT stands for social influence, habit formation, individual self, feelings and cognition, and tangibility—each a key factor in whether a consumer makes green (or not-so-green) choices. Social influence is one of the most powerful tools available, White said. For example, a study in California led by New York University Stern School of Business associate professor of marketing Bryan Bollinger, PhD, found that every installation of solar panels on a home in a given ZIP code increased the likelihood of another install by 0.78 percentage points ( Marketing Science , Vol. 31, No. 6, 2012 ).

Habits refer to everyday behaviors, like getting coffee every morning in a disposable cup rather than bringing one’s own mug, White said. Any way to make the greener choice easier can help break unsustainable habits, she said. Individual self refers to what resonates with any given person. It’s relatively easy to connect with individuals who already care about sustainability, White said. But sometimes advertisers, marketers, and companies need to work a little harder to link a person’s preexisting values to sustainability.

For example, religious and cultural values can play a role in how people approach environmental values, said Elizabeth Minton, PhD, an associate professor of marketing at the University of Wyoming. “Western consumers view what’s important as sustaining the family unit, sustaining the community, and sustaining the loved ones,” Minton said. Framing sustainability—protecting the environment—as a way to protect family and community, then, becomes a way for marketers to encourage demand for sustainable products.

Research into feelings and cognition has found complex patterns. Some research suggests that while negative emotions such as guilt can prompt environmentally friendly actions, guilt should be deployed with care. For example, after the United Kingdom instituted a policy of charging a small sum for disposable plastic grocery bags, mass communications researcher Sidharth Muralidharan, PhD, of Southern Methodist University, conducted an online survey that found that women who reported high guilt over forgetting to carry reusable bags were more likely to carry them more consistently, but men with high levels of guilt weren’t, suggesting women were more susceptible to “green guilt” than men. In a follow-up experiment, Muralidharan and his colleagues exposed consumers to guilt-inducing advertisements based around either saving the environment or saving money by carrying reusable bags. They found that the environment-based ads were less effective at inducing guilt than the savings-based ads ( Journal of Advertising Research , Vol. 58, No. 3, 2018 ). In other words, guilt must be directed toward an effective target—which is not always related to sustainability—to work.

Finally, tangibility in the SHIFT framework refers to the need to link an action to real consequences, given that the outcome of any behavior is uncertain, White said. Focusing on the near-term benefits of sustainability, such as preventing current environmental degradation, can help, according to research led by Audhesh Paswan, PhD, a professor of marketing at the University of North Texas ( Journal of Consumer Marketing , Vol. 34, No. 5, 2017 ).

One big question is how younger generations of consumers will approach sustainable consumption. Gen Z—the colloquial term for anyone born between the late 1990s and around 2010—tends to hold consumer brands to high standards, said Brent Coker, PhD, a lecturer in marketing at the University of Melbourne. They’re savvy to marketing strategies and don’t like empty platitudes, he said, which can lead to anger at brands they perceive as doing social (or environmental) harm. However, social media marketing can lead to impulse purchasing in Gen Z, according to research by marketing lecturer Elmira Djafavora, PhD, of Northumbria University Newcastle ( Journal of Retailing and Consumer Services , Vol. 59, 2021), which could feed overconsumption.

Promoting health

Another area where consumers might need to put aside their immediate impulses for long-term benefits is when making health choices. As with sustainability, consumers may well be aware that a choice—such as buying a sugary beverage—isn’t in their ultimate best interest, but still make that choice nonetheless.

“We know that incentives and information don’t always work as well as we would hope them to,” said Leslie John, PhD, who has a doctorate in behavioral decision research and is an associate professor at Harvard Business School. “What I’ve been trying to do is use insights from psychology to make these tools much more effective at actually changing behavior.”

In one study, John and her colleagues explored whether putting warning labels on sugary beverages discourages their purchase. In a real cafeteria setting, the researchers tested three different types of warning labels: One label simply listed the caloric content of the soda. Another read, “Warning: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay.” A third label contained the same text but with accompanying images of an obese abdomen, a person self-injecting insulin, and rotten teeth. The researchers found that only the graphic warnings had a statistically significant impact, reducing the share of sugary beverages purchased from 21.4% to 18.2% ( Psychological Science , Vol. 29, No. 8, 2018 ). At the same time, in a result that could incentivize firms as well as policymakers, the study also showed that the warning labels didn’t reduce drink sales overall, as consumers chose to buy bottled water instead.

“They’re still buying something; they’re just buying something healthier,” John said of the consumers in the study.

Food-labeling research often lands at the intersection of politics and science. Christina Roberto, PhD, the director of the Psychology of Eating and Consumer Health (PEACH) Lab at the University of Pennsylvania’s Perelman School of Medicine, focuses her research on what she calls “strategic science,” which means that she collaborates with policymakers to develop research questions. For example, in 2018, the Philadelphia Department of Public Health approached Roberto for insights on what kind of label they could use to educate consumers about foods high in salt. Roberto and her colleagues tested a variety of label options for the department, including a saltshaker inside a triangle as required on New York City menus, and a traffic light option with red representing high-salt items. The saltshaker performed the worst in tests of consumer understanding of the symbols, while the traffic light was the clearest. Unfortunately, the traffic light was a legal no-go, Roberto said, because the interpretation of which items got the red light could easily be challenged by food companies in court.

The researchers were also able to show in their data that putting text that read “sodium warning” next to the saltshaker symbol significantly boosted consumer understanding of the label. “We basically said, ‘Look, if you have to compromise and you have to use the saltshaker triangle, at least get the words ‘sodium warning’ next to it,’” she said.

That labeling strategy went into effect in September 2019 in Philadelphia restaurant chains with 15 or more locations. Boosting the potential effectiveness of the warning was a win, Roberto said, because if Philadelphia had used New York’s symbol without changes, that symbol likely would have become the standard for any other cities or states planning to institute sodium warning labels. Now, she said, there is an existing label with a stronger evidence base that new cities can choose to adopt in the future.

Money matters

Consumer psychologists are also tackling big-picture issues in the realm of money management, an area of great interest since many Americans are in precarious financial positions. According to a Congressional Research Service report, unemployment was elevated throughout 2020, peaking at 14.8% in April ( Unemployment Rates During the COVID-19 Pandemic: In Brief, 2021 ). Savings rates rose sharply, however, hitting 33% of people’s disposable incomes that same month as Americans halted their spending. As of February 2021, the savings rate had declined to 13.6% ( Bureau of Economic Analysis , 2020 ).

Researchers tackle consumer spending and saving in multiple ways. One strategy is to study what types of spending make people happiest. On that front, the research is clear: Buying experiences generally makes people happier than buying stuff. Experiential consumption also seems to trigger a greater sense of gratitude than material consumption, and it can even make people more generous to others in lab-based economic games, according to research led by psychologist Jesse Walker, PhD, an assistant professor of marketing at The Ohio State University ( Emotion , Vol. 16, No. 8, 2016 ).

“This is kind of cool because it suggests that these social benefits of experiential consumption don’t just apply to the consumers themselves but to those around them as well,” said Amit Kumar, PhD, a psychologist and assistant professor of marketing at the University of Texas at Austin’s McCombs School of Business, who coauthored that research.

Experiential consumption seems to make people happier because it strengthens social ties, Kumar said. People tend to bond over conversations about their trips to Italy more than they do about that new furniture set they bought at Ikea. That’s an important thing to know when weighing how to spend your hard-earned money, Kumar said.

But there can be a dark side to the glow of experiential purchases. People are more willing to go into debt for experiential purchases than for material purchases, according to research by Eesha Sharma, PhD, an associate professor of business administration at Dartmouth’s Tuck School of Business ( Journal of Consumer Research , Vol. 44, No. 5, 2018 ). This seems to be because experiences are often time-dependent, Sharma said. If you decide to delay the purchase of a dining room table from July until December, it doesn’t feel like you’ve missed out on owning the table. If you delay your summer beach trip from July until December? Well, then you’ve missed summer vacation altogether.

In general, consumers tend to maintain positive illusions about their own money management, said Emily Garbinsky, PhD, a psychologist and assistant professor of marketing at the University of Notre Dame. Garbinsky is researching ways to “gently shatter” these illusions at the point at which people make savings decisions, perhaps during the use of banking apps. There is evidence from other research that software nudges can boost real-world savings. For example, a field experiment using TurboTax’s free edition led by Duke University professor of psychology and behavioral economics Dan Ariely, PhD, nudged low- and middle-income tax filers to save a portion of their tax refunds. Compared with a control group that received no messaging, the taxpayers who were presented a message about the importance of emergency savings and given choices of ways to save their refund increased deposits to their savings accounts by 50% ( Behavioral Science & Policy , Vol. 3, No. 2, 2017 ).

Garbinsky’s work also zeroes in on how emotions affect money management decisions. She and her colleagues have found, for example, that couples who share bank accounts are more likely to make utilitarian purchases than hedonic ones, in contrast with couples who keep separate bank accounts ( Journal of Consumer Psychology , Vol. 29, No. 3, 2019 ). These results held in both lab and field experiments, as well as in analyses of real banking transactions. Other research under review suggests that couples who pool finances may have more relationship satisfaction, though the findings are correlational.

Often, consumer researchers study single decisions, such as how much money people save or how much debt they’re willing to take on—but money decisions don’t occur in a vacuum, Sharma said. If you’re borrowing money to save more for retirement, for example, it might look beneficial from a savings perspective but disastrous from a debt perspective.

“It’s really important for future research to look at multiple financial decisions together,” she said. “Research that integrates multiple financial decisions, looks at trade-offs, looks at decisions over time, will lead to a more nuanced and better understanding of these choices.” 

Further reading

Communicating sustainability for the green economy Kahle, L. R., & Gurel-Atay, E. (Eds.), Routledge, 2014

How psychological insights can inform food policies to address unhealthy eating habits Roberto, C. A., American Psychologist , 2020

Sustainable consumer behavior Trudel, R., Consumer Psychology Review , 2019

The elusive green consumer White, K., et al., Harvard Business Review , July/August 2019

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• v.23(9); 2021 Sep

Evolutionary Overview of Consumer Health Informatics: Bibliometric Study on the Web of Science from 1999 to 2019

1 The Third Xiangya Hospital, Central South University, Changsha, China

2 School of Life Sciences, Central South University, Changsha, China

3 Key Laboratory of Medical Information Research, Central South University, College of Hunan Province, Changsha, China

Wenzhao Xie

Tingxiao wen, xiaoqing peng, pingping dai, yifeng yuan.

4 The Second Xiangya Hospital, Central South University, Changsha, China

Associated Data

Cluster network of the themes (2009-2014).

Cluster network of the themes (2015-2019).

Consumer health informatics (CHI) originated in the 1990s. With the rapid development of computer and information technology for health decision making, an increasing number of consumers have obtained health-related information through the internet, and CHI has also attracted the attention of an increasing number of scholars.

The aim of this study was to analyze the research themes and evolution characteristics of different study periods and to discuss the dynamic evolution path and research theme rules in a time-series framework from the perspective of a strategy map and a data flow in CHI.

The Web of Science core collection database of the Institute for Scientific Information was used as the data source to retrieve relevant articles in the field of CHI. SciMAT was used to preprocess the literature data and construct the overlapping map, evolution map, strategic diagram, and cluster network characterized by keywords. Besides, a bibliometric analysis of the general characteristics, the evolutionary characteristics of the theme, and the evolutionary path of the theme was conducted.

A total of 986 articles were obtained after the retrieval, and 931 articles met the document-type requirement. In the past 21 years, the number of articles increased every year, with a remarkable growth after 2015. The research content in 4 different study periods formed the following 38 themes: patient education , medicine , needs , and bibliographic database in the 1999-2003 study period; world wide web , patient education , eHealth , patients , medication , terminology , behavior , technology , and disease in the 2004-2008 study period; websites , information seeking , physicians , attitudes , technology , risk , food labeling , patient , strategies , patient education , and eHealth in the 2009-2014 study period; and electronic medical records , health information seeking , attitudes , health communication , breast cancer , health literacy , technology , natural language processing , user-centered design , pharmacy , academic libraries , costs , internet utilization , and online health information in the 2015-2019 study period. Besides, these themes formed 10 evolution paths in 3 research directions: patient education and intervention, consumer demand attitude and behavior, and internet information technology application.

Conclusions

Averaging 93 publications every year since 2015, CHI research is in a rapid growth period. The research themes mainly focus on patient education, health information needs, health information search behavior, health behavior intervention, health literacy, health information technology, eHealth, and other aspects. Patient education and intervention research, consumer demand, attitude, and behavior research comprise the main theme evolution path, whose evolution process has been relatively stable. This evolution path will continue to become the research hotspot in this field. Research on the internet and information technology application is a secondary theme evolution path with development potential.

Introduction

The concept prototype of consumer health informatics (CHI) was first proposed by Kenneth R. Thornton of the School of Health Information Science (University of Victoria) in 1994. Kenneth R. Thornton also elaborated 4 important research directions: network evolution, automation of the patient record, outcome and other quality-related databases, and consumer health education [ 1 ]. In 1995, Ferguson [ 2 ] of the Harvard University School of Medicine put forward the concept of consumer health informatics (CHI) for the first time in his paper. He pointed out that CHI is a branch of science that studies the application of computer and wireless communication technology in consumer health care [ 2 ]. Eysenbach [ 3 ] proposed that CHI is the branch of medical information that does the following: analyses the consumers’ needs for information; studies and implements methods of making information accessible to consumers; and models and integrates the consumers’ preferences into medical information systems. This definition has been cited by the academic community more than 300 times. The American Medical Informatics Association defines CHI as the field devoted to informatics from multiple consumer or patient views and which includes patient-focused informatics, health literacy, and consumer education [ 4 ]. CHI is an interdisciplinary subject that includes nursing information, public health, health promotion, health education, library science, and communication science [ 4 ].

With the rapid development of computer and information technology, the continuous popularization of the internet, and the continuous strengthening of people’s health awareness, consumption awareness, and information literacy for making health decisions, increasingly more people obtain health-related information through the internet. Because of the interdisciplinary nature of CHI, there is no consensus on the definition of CHI. However, the core content of various definitions can be summarized as follows: CHI emphasizes consumers or users as the center and takes consumers or users and computer and information technology as the research object to explore how to use computer and information technology to meet consumers’ health or medical information needs. It is a discipline that helps consumers access relevant health or medical information and make decisions about health care and health promotion.

Previous studies have analyzed and summarized the research progress of CHI. For example, Eysenbach [ 3 ] collected literature, internet information, and reports related to CHI before 2000 and summarized the research progress of CHI in the context of health care in the information age, medical knowledge delivery to consumers, the accessibility of electronic health records to patients, decision aids to support the consumers’ choices, the quality control of health information on the internet, and other aspects. Kokol et al [ 5 ] carried out a bibliometric analysis on the literature related to health informatics and electronic health for the period 1984-2015 and discussed the current research status in this field, including trends in literary production, the geographic and journal distribution, and theoretical analyses. However, their research only clusters all research topics and does not reflect the dynamic changes in research themes at different times. Zhao and Zhang [ 6 ] reviewed the literature about consumer health information seeking in social media before 2016 and discussed the characteristics of existing research from the following perspectives: the prevalence of health information seeking in social media, discussion topics emerging from health information in social media, seeking health information from online peers, social and emotional support from social media, concerns of accessing consumer health information in social media, and other aspects. However, they did not discuss the dynamic evolution path and the evolution rules of the research themes of CHI. Further, many of these studies are qualitative research. There is also considerable subjectivity in the selection of literature, identification of important topics, and prediction of research frontiers. The combination of qualitative and quantitative analysis methods can increase the objectivity, accuracy, and comprehensiveness of the research results [ 7 ]. Bibliometrics is a measurable informatic method [ 8 ], and is often used to discover top journals and authors in a field, identify research progress [ 9 ], and predict research trends [ 10 ].

Many bibliometrics visualization tools are available, such as SciMAT, CiteSpace, UCINET, HistCite, VOSviewer. The full name of SciMAT is the Science Mapping Analysis tool. In 2012, it was developed by Cobo, López-Herrera, Herrera-Viedma, and Herrera at the Department of Computer and Artificial Intelligence in Granada University, Spain. It can be used for data preprocessing, data network analysis documentation, and result visualization. It can also be used to produce 4 kinds of maps: an overlapping map, an evolution map, a strategic diagram, and a cluster network [ 11 ]. Compared with other bibliometric visualization tools, SciMAT is unique in expressing the evolution of the theme and performs excellently in longitudinal timing analysis [ 7 ].

Overall, there have been few achievements in the field of CHI research based on bibliometrics, and the dynamic evolution of the research theme of CHI has not been explored. Therefore, this article conducted a bibliometric analysis to present the evolutionary overview of CHI by using SciMAT. The main research questions of this paper are as follows:

• What was the development trend of CHI research in 1999-2019?
• What is the main research direction of CHI research?
• How does the theme of CHI research evolve?
• What are the research trends of CHI?

In bibliometrics, to obtain the research topic of a certain research field in a specific period, it is common to carry out keyword co-occurrence analysis and cluster analysis on the literature collected and to obtain the development path and state of the research topic through a comparative analysis of the split and fusion of research themes in different periods. This paper uses SciMAT tool to draw the research themes’ knowledge map, analyzes the research themes and evolution status of CHI in different study periods using a strategic diagram and data flow, and discusses the dynamic evolution path and evolution law of the research themes of CHI.

The analysis framework of this paper is shown in Figure 1 , which is mainly divided into 4 parts: data acquisition, data preprocessing, software operation, and results analysis.

Analysis framework of consumer health informatics evolutionary.

Data Sources and Retrieve Strategies

The Web of Science core collection database of the Institute for Scientific Information is an important database for obtaining global academic information [ 7 ]. It consists of the Science Citation Index Expanded, Social Sciences Citation Index, Arts & Humanities Citation Index, and so on. Users can access core academic literature from the fields of natural sciences, social sciences, biomedicine, engineering, arts, and humanities from the database. Therefore, we selected Web of Science as the data source. In this database, subject retrieval was used, and the search terms were “consumer health informatics”, “consumer health information”, “consumer medic * informatics”, “consumer medic * information”. The publication years were limited to 2019 and before. All languages were selected. Selecting all languages provides a more comprehensive coverage of the literature on this topic. Non-English articles generally have English titles, abstracts, and keywords, from which one can understand their main research content. For these articles, we also used translation software to read the full text and obtained the main research content. The literature types were limited to articles, proceeding papers, and reviews. All papers were retrieved on May 2, 2020. A total of 986 documents were obtained, of which 931 met the document-type requirement. The downloaded data were saved in a text format that SciMAT could read directly.

Data Preprocessing

To accurately obtain the research themes in this field, it was necessary to perform data cleaning. SciMAT was used to clean keyword information. First, SciMAT’s cleaning function “find similar words by Plurals (automatic)” automatically merges the singular and plural expressions of keywords, such as “attitude“ and “attitudes” into “attitudes”. Then, similar words with different forms and abbreviations were merged by hand. For example, “consumer health information technology,” “consumer health IT,” “consumer health information technologies,” and “consumer health information technology (CHIT)” were merged into “ consumer health information technology.” synonyms, such as “physician patient relations,” “physician–patient relationship,” “patient–physician relationship,” “doctor–patient relationship,” “doctor–patient relations,” and “doctor–patient relationships” were merged into “doctor–patient relationship.” Some words, such as “consumer health information,” “consumer health informatics,” “association,” and “campaign,” which had high frequency and broad meaning and that might cover the association between other micro words, were deleted.

Parameter Settings

Words (the author’s words and the source’s words) were selected as the units of analysis. The data reduction thresholds of the 4 study periods are 1, 1, 1, and 2, and the type of analysis matrix is co-occurrence. The network reduction thresholds are 1, 1, 1, and 1, and the network normalization method is the equivalence index. The clustering algorithm used was the simple centers algorithm. The maximum network value was 15 and the minimum network value was 3, and the scale of the cluster network was limited to a reasonable range. The H-index and sum citations were selected as the measurement indexes of clustering quality. Jaccard’s index and the Salton index were selected as similarity measurement methods for the evolution map and the overlapping map, respectively.

Overall Characteristics Analysis

Trends in the number of articles.

The number and trend of the articles published each year in a certain field can reflect the scholars’ attention to this field. As shown in Figure 2 , the amount of literature can be divided into 3 stages: slow growth, stable growth, and rapid growth. The 1999-2003 period was the first stage, with an average of 12.2 papers published each year. The period from 2004 to 2014 was the second stage, with an average of 36.6 papers published each year. The period from 2015 to 2019 was the third stage. After 2015, the number of articles increased substantially, with an average of 93.4 papers published each year. The volume of published articles peaked in 2019 at 112, with an annual total accounting for 12.0% (112/931) of all literature.

Consumer health informatic research documents published from 1999 to 2019.

Based on the trend of literature growth, this paper divides the research on CHI into 4 study periods: 1999-2003, the first study period; 2004-2008, the second study period; 2009-2014, the third study period; and 2015-2019, the fourth study period. The number of articles in the 4 study periods is 61, 124, 279, and 467.

Overlapping Map Analysis

An overlapping map uses the number of keywords to represent the number of themes at each period and shows the stability of a research theme in a certain field in the form of a data flow. Figure 3 is an overlapping map of CHI research for the period from 1999 to 2019 and clearly shows the emerging and declining themes in this field. The 4 circles in the figure represent the 4 study periods. Displayed from left to right, they are as follows: the 1999-2003 study period, the 2004-2008 study period, the 2009-2014 study period, and the 2015-2019 study period. The number of themes in the first, second, third, and fourth study periods is 52, 95, 163, and 184, respectively. As can be seen, the number of themes increases rapidly.

Overlapping map of the consumer health informatics research from 1999 to 2019.

From 1999 to 2003, a total of 32 themes were passed to the next study period, and the stability index with the next study period was 14.57. In this study period, the research on CHI remains in a slow-growth stage, which is part of the basic research stage. The number of new themes in the 2004-2008 study period was 63. In the 2009-2014 period, 85 themes were continued from the previous study period, and the stability index between the 2 study periods was 58.06. Reflecting the steady growth of CHI research and the steady increase of research articles in these 2 study periods, many emerging themes and a small number of declining themes were included. There were 40 new themes in the 2015-2019 study period, and the stability index between this and the previous study period was 119.74. At this point, the number of themes is increasing steadily, which reflects that the research area of CHI is gradually expanding, and the research content is becoming increasingly richer.

Analysis of Highly Cited Articles

Six of the top 10 highly cited articles in this field came from the 1999-2003 study period ( Table 1 ), and the cited frequency of the articles is ranked as the first, second, third, fifth, sixth, and tenth. This reflects that the papers published in this period form the basis of the research on CHI and play a fundamental role in the research in this field. The most frequently cited paper (940 times) is an empirical study of the quality evaluation of online consumer health information. The evaluation of health-related websites is quite different due to the differences in research methods, preciseness, quality standards, research population, and subjects. Therefore, the operability of quality standards needs to be defined [ 12 ]. The second most frequently cited (804 times) paper is the one by Cline in 2001 [ 13 ]. This paper summarizes, from the perspective of communication, the potential benefits and comprehensive quality of online consumer health information searching and identifies and discusses the criteria of online health information evaluation. In 1999, Charnock et al [ 14 ] developed a tool named DISCERN, which can be used by health information providers and consumers to judge the quality of written consumer health information about treatment options. This paper was cited 521 times. At present, DISCERN has become a highly useful tool for the quality evaluation of network health information. Many scholars use this tool to evaluate the quality of online health information about different diseases and published in different languages. For example, Cerminara et al [ 15 ] used the DISCERN tool to evaluate the reliability, accuracy, and relevance of the top 50 links for childhood epilepsy (online information) displayed by the Google search engine. Alnaim [ 16 ] used the DISCERN tool to assess the quality of information published on websites that share breast cancer information online in Arabic.

Top 10 cited articles in the consumer health informatics research field.

Four of the top 10 highly cited articles in the field of CHI research came from the 2004-2008 and 2009-2014 study period ( Table 1 ). The paper “eHealth literacy: Essential Skills for Consumer Health in a Networked World” was published in the Journal of Medical Internet Research in 2006. In this article, the concept of eHealth literacy was defined for the first time. The ability to find, discover, understand, and evaluate health information from electronic resources, and the ability to apply the acquired knowledge to solve health problems were also explained in this paper [ 17 ]. Ranking fourth in the number of citations, the paper was cited 514 times. eHealth literacy has become a mature research topic, and increasingly more scholars are paying attention to it. For example, Kim et al [ 18 ] examined the association among eHealth literacy, perceived benefits, self-efficacy, and health-promoting behaviors in patients with type 2 diabetes. Cherid et al [ 19 ] investigated the level of mobile technology acceptance, health literacy, and electronic health literacy of 401 patients aged over 50 years with recent fractures.

Evolutionary Characteristics Analysis

Design and overview.

The strategic map is mainly used to describe the relationship between themes and the relationship strength within the theme to reflect the importance of the theme in the development of the whole field and the development of the theme. The node in Figure 4 is a cluster, and the sizes of the nodes indicate the sizes of the theme clusters. The horizontal axis is the centrality, which measures the relevance of the theme to other themes. With higher centrality, the theme is more important in the whole field. The vertical axis is the density, which measures the relational strength of the cluster keywords within a theme. The higher the density of the theme, the more mature the theme. The strategic map is divided into 4 quadrants. Quadrant 1 (Q1) contains motor themes, quadrant 2 (Q2) contains highly developed and isolated themes, quadrant 3 (Q3) contains emerging or declining themes, and quadrant 4 (Q4) contains basic and transversal themes. The strategic map of the 4 study periods, the relevant bibliometrics indicators, and the evolutionary status of the research themes are as follows.

Strategic diagram of themes for the subperiod of 1999-2003 (A: based on the publications, B: based on the citation frequency).

Themes (n=4) in 1999-2003: Patient Education, Medicine, Needs, and Bibliographic Database

The theme of Q1 is medicine , which has the highest density value and a higher centrality ( Table 2 and Figure 4 ). The keywords closely connected to medicine are search engine, interventions, and challenges ( Figure 5 ). The websites and pages displayed by search engines have become the main source from which people obtain medical and health information [ 25 ]. Health information/support systems for health promotion are also emerging, such as the CHESS comprehensive health promotion support system [ 20 ].

Performance measures for the themes of the subperiod 1999-2003.

Cluster network of the themes (1999-2003).

The theme of Q2 is bibliographic database , which has centrality and density values of 1.25 and 66.67, respectively. The theme is closely related internally and has low relevance with other themes. The amount of relevant literature is the least, as the theme has not attracted the attention of the academic circle. The keywords closely connected to bibliographic database are search interface and women’s health . For the prototype network interface of the women’s health bibliography database, Marton et al [ 26 ] performed a comparative analysis from 3 aspects: web interface design, overall visual effect, and hypertext navigation and information organization.

Patient education is located on the centrality axis and has the highest centrality. Patient education has the largest amount of research literature and has been cited the most times, indicating that it is an area of high concern and has had a great impact on later research. Patient education is interconnected with many different keywords, such as world wide web and system, but the connection is not strong. The result of the cluster network shows that the internet and information systems are important tools and approaches in patient education [ 13 ] and that individualized customized education can be carried out for patients through computers [ 27 ]

Needs is located on the density axis and has centrality and density values of 1.85 and 12.5, respectively. The cluster network shows that needs is connected with population and information seeking . The internal demand for health information drives millions of consumers to search for health information on the internet. If the search terms used by consumers do not match the terms set at the information source, the search results will not meet the needs of consumers. Therefore, consumer health information retrieval needs a full range of terminology support [ 28 ].

Themes (n=9) in 2004-2008: World Wide Web, Patient Education, eHealth, Patients, Medication, Terminology, Behavior, Technology, and Disease

The themes of Q1 have higher centrality and density ( Table 3 and Figure 6 ) and are world wide web , patient education , eHealth , and medication . World wide web has the largest amount of research literature and has been cited 635 times. The cluster network shows that the relationship between the world wide web and internal keywords is weak. The keywords that are strongly connected to patient education are internet health information , record , and challenges ( Figure 7 ). Patient education is an important part of providing health care services and helps to improve the effect of medical care. Doupi and van der Lei [ 29 ] discussed the possibility of integrating electronic medical record data and online health information resources to provide personalized patient education for patients. eHealth has the highest density and a relatively high centrality; the cluster network reveals that it is closely related to health communication , tailored intervention, cell phone, and teleconsultation , which is an important research topic in this field. Tufano and Karras [ 30 ] used teleconsultation for an obesity intervention that was expected to achieve mass customization function, interactive function, and national customized electronic health information. The location of medication is far from the centrality axis and close to the density axis. The cluster network shows that it has a strong relationship with health literacy and pharmacist . In the research on drug treatment in the field of CHI, scholars are concerned about the health literacy of consumers and whether they can understand the accompanying instructions of drugs [ 31 ]. Webb et al [ 32 ] have proposed that the design of patient-centered consumer medication information can improve the comprehensibility of warning labels.

Performance measures for the themes of the subperiod of 2004-2008

Strategic diagram of themes for the subperiod of 2004-2008 (A: based on the publications, B: based on the citation frequency).

Cluster network of the themes (2004-2008).

The theme of Q2 is technology , with centrality and density values of 18.49 and 41.2, respectively. The important nodes that are connected internally are tools and adults . The literature corresponding to cluster nodes reveals that scholars began using internet technology to intervene in people’s health activities [ 22 ].

The themes of Q3 are terminology , behavior , and disease , which have centralities of 3.85, 2.38 and 16.39, respectively, and density values of 16.67, 17.59, and 8.33, respectively. Terminology is only associated with natural language processing and users . The literature corresponding to terminology reveals that the rapid development of consumer health education websites and other applications has promoted research on consumer health vocabulary and that term recognition [ 33 ] is one of the important research directions. Disease has weak internal relations. Behavior is associated with libraries , HIV infection , and information seeking . By studying the literature corresponding to behavior , we found that researchers had analyzed health information searching behavior according to different populations. For example, Hesse et al [ 34 ] analyzed the 2005 Administration of the Health Information National Trends Survey data to explore the information searching behavior of survivors of cancer and found that their information searching behavior was very common and would not decrease with time.

The theme of Q4 is patients , with centrality and density values of 33.26 and 16.05, respectively. The internal correlation of the patients theme cluster was not strong. An examination of the literature corresponding to cluster nodes revealed that scholars paid more attention to the research of the patients’ attitude, cognition, and intention regarding health information [ 35 ].

Themes (n=11) in 2009-2014: Websites, Information Seeking, Physicians, Attitudes, Technology, Risk, Food Labeling, Patient, Strategies, Patient Education, and eHealth

The themes of Q1 are information seeking , physicians , and attitudes , which have centralities of 69.64, 67.77, and 64.83, respectively, and density values of 37.42, 19.27, and 28.02, respectively ( Table 4 and Figure 8 ). The cluster network ( Multimedia Appendix 1 ) shows that there are 15 nodes and 25 links in information seeking and that the keywords closely related to information seeking are search interface , management program , and community . The literature corresponding to information seeking revealed that scholars analyzed, from the perspective of consumers, the content of online questions, explored the influencing factors of health information searching, and designed a new connected exploratory navigation interface to improve the effectiveness of health information searching [ 36 ]. Attitudes had the highest citation frequency, indicating that it had a great influence on the subsequent research. The cluster network shows that attitudes is associated with a large number of different keywords, but the relationship is not strong; among these different keywords, the closely related nodes are community pharmacies , information and communication techniques , and electronic medical records . The cluster network reveals that the nodes that are close to physicians are interviews , patient centered care , patient–provider relationship , and teleconsultation . The literature corresponding to attitudes and physicians reveals that the consumers’ attitude toward, access to, and use of online information related to diseases [ 37 ], medicines, diet, and other health issues are the research hotspots in this period. For example, Amicizia et al [ 38 ] believes that information and communications technology provide an opportunity for health care workers to use mobile internet to disseminate vaccine-related knowledge interactively and entertainingly and to monitor adolescent attitudes toward vaccination through social media.

Performance measures for the themes of the subperiod of 2009-2014.

Strategic diagram of themes for the subperiod of 2009-2014 (A: based on the publications, B: based on the citation frequency).

The themes of Q2 are patient education , eHealth , and food labeling , which have centralities of 40.51, 30.79, and 6.56, respectively, and density values of 31.32, 37.44, and 15.62, respectively. The cluster network shows that patient education is closely related to smartphone, pamphlet, resources , and Alzheimer’s disease . Scholars mainly conducted research from 3 aspects: patients’ health education needs [ 39 ], the effect of health education materials, and health information technology. For example, Kraschnewski et al [ 40 ] studied how pregnant women use the internet and mobile phone technology to acquire health care knowledge. They found that women thought that the educational materials they received during prenatal care were not helpful, and therefore, they turned to the internet and smartphone apps to fill the knowledge gap [ 40 ]. There are 9 nodes and 12 connections in the eHealth theme. Compared with the previous study period, in this study period, there are fewer nodes and connections. The research content of the theme is more concentrated. The keywords closely related to eHealth are tailored intervention , and online health information . Scholars are concerned about how to use information and communication technology to help patients improve their health status and strengthen their self-health management skills [ 41 ]. For example, as a health literacy intervention for Hispanic patients with AIDS, Jacobs et al [ 42 ] developed a Spanish-language computer application, which can provide information about HIV infection, treatment, and drugs. Food labeling is a new theme, for which the cluster network shows the related keywords are consumer opinions, recommendations, and ratings . King et al [ 43 ] investigated the consumers’ understanding of common terms used to guide food consumption frequency and quantity and found that some terms are highly subjective and that more simple and clear terms need to be developed.

The themes of Q3 are patients and strategies , which have lower centralities and density values. The cluster network reveals that the keywords strongly related to patients were health information service , information behavior , and conflict of interest . Strategies is an emerging theme. The cluster network shows that the keywords associated with it are only evidence-based practice and task and that the weight of the connection is 0.17.

Having higher centralities and lower density values, the themes of Q4 are websites , technology , and risk . The cluster network shows that the keywords closely related to websites are world wide web , evaluation studies , tools , email . By studying the literature corresponding to websites , it is found that the research on the content evaluation of websites and health information intervention through websites are the research hotspots in this period [ 44 ]. Thakor et al [ 45 ] investigated the information quality of ecommerce websites selling Hypericum perforatum and found that most sites received poor reviews and lacked information on drug interactions, contraindications, and adverse reactions. The keywords closely related to technology are home telehealth and aging . With the aggravation of the aging of the population, the research on home telehealth for the aged group has attracted much attention. Cimperman et al [ 46 ] studied the important factors affecting the elderly’s adoption of home telehealth services and found that the following factors play an important role in the perception of home telehealth: perceived usefulness, expectation, social influence, perceived security, computer anxiety, convenience, and the doctor’s opinion [ 46 , 47 ]. Risk is split from medication . The cluster network shows that the relationship between internal keywords is weak and that the relatively strong ones are costs , patient decision aid , and cardiovascular disease . For veterans with and without multiple sclerosis, Cameron et al [ 48 ] studied the relative risk of falling and requiring medical care and found that the adjusted odds ratio of falling was 3 times higher for female veterans with multiple sclerosis than for female veterans without multiple sclerosis.

Themes (n=14) in 2015-2019: Electronic Medical Records, Health Information Seeking, Attitudes, Health Communication, Breast Cancer, Health Literacy, Technology, Natural Language Processing, User-Centered Design, Pharmacy, Academic Libraries, Costs, Internet Utilization, and Online Health Information

The themes of Q1 are electronic medical records , health information seeking , attitudes , and breast cancer , with centralities of 53.52, 47.78, 45.18, and 48.08, respectively, and density values of 19.71, 18.14, 8.89, and 7.11, respectively ( Table 5 and Figure 9 ). The cluster network ( Multimedia Appendix 2 ) shows that electronic medical records has a strong relationship with internal keywords, which include personal health information management and care partner . Scholars mainly focus on the patients’ health information management, including the sharing of access to the patients’ health records, personal health data visualization, and other contents. For example, Wolff et al [ 49 ] sent the doctor’s medical records to patients and authorized nurses through OpenNotes. The scholars verified the acceptability and effect of this approach, and the results showed that it was acceptable for patients and their nursing staff to view the doctors’ medical records; the results also reflected that this method improved the communication with patients and enhanced the patients’ confidence in cooperating with nurses. Keywords closely related to health information seeking are users , behavior , health information needs , and consumer health information behavior . An examination of the literature corresponding to important nodes revealed that the users of library, online health consultation platform, social media, and other media were often considered research objects and that a discussion of these users’ health information needs and behaviors was a research hotspot in this period [ 50 , 51 ]. For example, taking the online health consultation case on “Taiwan eDoctor,” an online health consultation platform, as the research object, Chiu et al [ 52 ] studied the length, time, communication mode, purpose, and identity disclosure of online consultation questions and described the communication mode of patients in the process of health information searching. Attitudes was closely related to internal keywords, such as HPV vaccines , risk , evaluation studies , and physicians . Systematically studying the rankings, quality, and contents of the web pages related to HPV vaccines, Fu et al [ 53 ] classified the included web pages into critical and noncritical ones and found that the quality of the critical web pages was poor but that the critical web pages often obtained higher rankings. Keywords closely related to breast cancer are online health communities , support groups , and preferences . The scholars mainly focused on the content analysis of the online health community [ 54 ] and its supporting role for patients with cancer. For example, through interviews and questionnaires, Huh et al [ 55 ] developed online health community roles to reflect the users’ needs and requirements when using an online health community. These roles can help provide users with customized social support and patient support. The study found that the roles of online health communities can be divided into 4 categories: managers, opportunists, scientists, and adventurers. These roles reveal user interaction behavior and attitude patterns when using online health communities.

Performance measures for the themes of the subperiod 2015-2019.

Strategic diagram of themes for the subperiod of 2015-2019 (A: based on the publications, B: based on the citation frequency).

The themes of Q2 are pharmacy , online health information , and academic libraries , with centralities of 16.52, 4.52, and 7.82, respectively, and density values of 28.49, 9.03, and 6.49, respectively. A mature professional theme ( pharmacy ) has the highest density and is close to the density axis. The keyword most closely related to pharmacy is patient medication information . Monkman and Kushniruk [ 56 ] studied consumer medication information in pharmacies and found that the organization and presentation of online consumer medication information need to be improved. The content of consumer medication information needs to be improved in order to promote the safety and effective use of drugs [ 57 ]. The keywords in the online health information cluster network include video , web 2.0, and world wide web . Scholars mainly pay close attention to the use and quality evaluation of online health information [ 58 ]. As an emerging theme, academic libraries has the lowest centrality, the lowest amount of relevant literature, and the lowest citation frequency.

User-centered design , with centrality and density values of 11.9 and 6.3, respectively, is located on the centrality axis. One of the keywords clustering with user-centered design is smartphone apps . An examination of the key literature corresponding to cluster networks reveals that scholars focus on designing user-centered, smartphone-based mobile health apps, such as nutrition education apps that, for example, provide technical support for adolescents with overweight and obesity [ 59 ].

Having lower centralities and density values, the themes of Q3 are internet utilization and costs . The internal relationship between internet utilization and costs is weak; both are in an immature development stage and have little impact. The cluster network shows that the keywords in costs include search engine and health records ; the keywords in internet utilization include health behavior , systematic review , and patient education as topic . The literature corresponding to internet utilization reveals that the content of relevant literature involved patients using the internet to search for health information for self-care. For example, Jamal et al [ 60 ] studied the online health information searching behavior of patients with type 2 diabetes in the Middle East and its influence on their self-care behavior. The results showed that most internet health information searchers had positive changes in their behaviors after searching and had a stronger awareness of diabetes self-care [ 60 ].

Natural language processing is located on the density axis, with centrality and density values of 24.1 and 4.18, respectively. The cluster network shows that natural language processing is connected with consumer health vocabulary , state , online support groups , and text . An examination of the core literature corresponding to the cluster shows that most scholars mined and dealt with the health-related contents of consumers through social media, health websites, health forums, and other ways to obtain the users’ health needs, explore the users’ health behaviors, and investigate the application of health information technology [ 61 , 62 ].

The themes of Q4 are health communication , health literacy , and technology , with centralities of 57.98, 50.29, and 54.79, respectively, and density values of 4.7, 3.55, and 3.46, respectively. The technology cluster network formed 15 nodes and 21 wires, but the internal relationship was very weak. Health communication has the highest centrality and has many connections with external themes. It is a key theme with development potential. The cluster network shows that health communication is strongly related to keywords such as medicine , telehealth , and perspectives . Benis et al [ 63 ] studied the use of communication channels between patients and health care organizations. By matching the communication channels with the patients’ personal information, the communication between medical institutions and patients can be transformed into a more active mode, and the patient’s participation can be improved. Health literacy is an emerging theme; it has the largest number of related literature and the largest citation frequency sum. The keywords closely related to health literacy include skills , patient education , and public libraries . Health literacy is the ability of individuals to access and understand health information and to use it to maintain and promote their health. An examination of the literature of important nodes reveals that scholars pay more attention to the assessment and intervention of health literacy [ 64 ] and the assessment of internet health information quality [ 65 , 66 ].

Evolutionary Path Analysis

The theme evolution map shows, through a data flow, the evolution of the 4 study period themes of CHI research. It can analyze and track the dynamic evolution of the themes in the field of CHI research over a period. Figure 10 shows the CHI research field’s theme evolution map. Each column in the figure represents a study period. In the figure, the nodes represent the research themes, and the size of the nodes is proportional to the number of related articles of the research themes. The connection between the nodes represents the theme data flow, the solid line represents the main keywords shared by 2 themes, and the dotted line represents the shared keywords are not the main keywords. The width of the connection is proportional to the Inclusion index [ 11 ].

Thematic evaluation map of the consumer health informatics research field (1999-2019).

From Figure 10 , it can be seen intuitively that patient education and technology appear in 3 study periods, and that eHealth , attitudes , and patients appear in 2 study periods. With time, the circle in the theme evolution map becomes larger, the number of the research themes increases, and the data flow between the research themes becomes increasingly complex. This reflects the emergence of new research themes and contents from 1999 to 2019. According to the theme evolution map, the size of the research theme circle, and the data flow between themes, 10 theme evolution paths of 3 research directions in the field of CHI were determined.

Supply-Side Research of Consumer Health Informatics: Patient Education and Intervention Research

Consumer health education is the process of assisting one to acquire the correct information and understanding so that one will be able to make wise decisions about a certain health item [ 67 ]. Patient education → patient education → patient education → health literacy , pharmacy (subpath 1). Patient education → world wide web → websites → health communication (subpath 2). Patient education → eHealth → eHealth → health literacy , breast cancer , health communication (subpath 3).

The 3 subpaths above evolved from the main and branch directions of the patient education theme in the first study period. Over time, the nodes on the evolutionary path become larger, the number of research articles increases, and the data flow from node splitting is greater. The data flow of patient education and intervention research evolution is relatively clear and represents the main path of the evolution theme of CHI. The theme on the path mainly moves between the first quadrant and the fourth quadrant, and the split and fusion of themes are obvious. In the second study period, subpaths 1 and 3 became the focus of research. In the third study period, the theme density increased and the centrality decreased, demonstrating a professional and mature research direction in the field. In the fourth study period, the themes split into several themes with great influence and development potential ( health communication and health literacy ). In the third study period, the subpath 2 integrated multiple themes, and the density of themes decreased. In the fourth study period, the theme split into several low-density but high centrality themes ( natural language processing ).

Consumer-Side Research of Consumer Health Informatics: Consumer Demand, Attitude, and Behavior

The evolutionary path of consumer demand, attitude, and behavior research consists of 3 subparts. Needs → patients → attitudes , physicians → attitudes , health literacy , health information seeking , internet utilization (subpath 1); medicine , needs → behavior → information seeking → health information seeking , health literacy (subpath 2); and medicine → diseases → patients → electronic medical records (subpath 3).

These 3 subpaths evolved from the main and branch directions of medicine and needs in the first study period. With time, the number of nodes on the evolutionary path increases, the number of research articles increases year by year, and the data flow of node splitting also increases. The themes in the evolutionary path of consumer demand, attitude, and behavior research mainly move between the first, third, and fourth quadrants, and the themes are divided and integrated. The theme of subpath 1 has gone through a stage in which centrality and density rise, and in this field, it finally forms many core themes, such as health information seeking , health literacy , and attitudes . In the second study period, subpath 2 splits to form a new theme ( behavior ). Later, this theme attracted the attention of many scholars in the field; its density and centrality increased rapidly, and it became the core theme in the field. In the second and third study periods, subpath 3 is an edge theme that is not of high concern. In the fourth study period, some themes ( attitudes, physicians, technology, patients, websites ) split and merge into a high centrality and density key theme ( electronic medical records ).

The Technology Research of Consumer Health Informatics: The Application Research of Internet and Information Technology

Currently, big data, internet plus, artificial intelligence, and other emerging information technologies have been tightly integrated with traditional medical and health industries. The application of internet and information technology in the field of CHI has attracted more attention from computer science and communication science scholars. The evolution path of internet and information technology application research consists of 4 subpaths. Medicine → technology → technology → technology , health communication (subpath 1); patient education → eHealth → eHealth → online health information (subpath 2); needs , bibliographic database → patients , world wide web → information seeking → natural language processing , user-centered design , academic libraries (subpath 3); and medicine → world wide web , terminology → websites → online health information , natural language processing , breast cancer (subpath 4).

These 4 subpaths evolved from the main directions of bibliographic database in the first study period as well as the branch directions of patient education and medicine . The number of research articles is gradually increasing, and the phenomenon of node splitting and fusion is also obvious. The theme of the evolution path of the internet and information technology application research mainly moves between the first, second, and fourth quadrants. The evolution path is relatively complex, which may be related to the application of information technology in different research directions. Subpath 1 emerged from the theme of the first study period, and the density decreased in the second study period. In the third and fourth study periods, the centrality increased. The density decreased after the split of multiple themes, and some important themes with strong influence and development potential developed. Subpath 2 divides from the theme of patient education in the first study period. In the second study period, a key theme with high centrality and density was formed. In the third and fourth study periods, the centrality decreased, and the density increased; it became a professional theme in the field. The data flow of subpaths 3 and 4 is relatively complex and is formed by the convergence of 2 routes in the first and second study period.

Overall Development Status of Consumer Health Informatics

In the past 21 years, CHI research has been on the rise and has gone through 3 stages: slow growth, stable growth, and rapid growth. In the early stage, the development was slow, the themes were few, and the intensity was low. In the later stages, the development became diversified. After 2015, the number of research papers on CHI increased substantially, and it became a hotspot of academic research. In 2019, it reached a peak of 112 papers, a research volume accounting for 12.03% of the total literature.

The period 1999-2003 comprises the basic research stage of consumer health information. Six of the top 10 highly cited literature in this field come from this study period. This literature constitutes the cornerstone of CHI research. Consumer health information evaluation tools, such as DISCERN, that were developed in this study period have become recognized mature tools in the field. The period 2004-2014 was one of steady growth in the research on CHI. During this period, fewer keywords disappeared, and more new ones were absorbed. In 2015-2019, the number of keywords was the largest, and the research content involved was increasingly more abundant. A similarity index for the fourth study period reached a higher level, reflecting that the research field of CHI had become more mature, the inheritance of research had become stronger, and researchers were continuing to focus on more research topics.

By analyzing the rise, decline, and the change in the density and centrality of the themes in different study periods, the evolution characteristics and status of the research themes can be reflected.

The motor themes include the following: medicine and patient education in 1999-2003; world wide web , patient education , eHealth , and medication in 2004-2008; information seeking , physicians , and attitudes in 2009-2014; and electronic medical records , health information seeking , attitudes , and breast cancer in 2015-2019. These themes have high centralities and density values. Besides, the research studies are popular and influential, and the internal relations within these themes are closely relevant. These themes are the core of the research field and their development is mature.

The highly developed and isolated themes include the following: bibliographic database in 1999-2003; technology in 2004-2008; eHealth , patient education , and food labeling in 2009-2014; and pharmacy , academic libraries , online health information , and user-centered design in 2015-2019. Having high-density values and low centralities, these themes do not represent the research center. They are mature and peripheral themes in this field.

The emerging or declining themes include the following: behavior , terminology , and disease in 2004-2008; patient and strategies in 2009-2014; and costs and internet utilization in 2015-2019. Because of their low centralities and density values, these themes have been weakly developed and are marginalized themes in this field.

The basic and transversal themes include the following: needs in 1999-2003; patients in 2004-2008; websites , technology , and risk in 2009-2014; and health communication , breast cancer , health literacy , technology , and natural language processing in 2015-2019. These themes have high centralities and low-density values, indicating that these have a high influence on the field of CHI but are not well developed.

By analyzing the evolutionary status of the themes in the 2015-2019 study period, the paper expects to predict the future development trend of the field. The centrality and density value of electronic medical records are extremely high. Although there are not many related documents, each document has been cited 14 times on average, indicating that it has received extremely high attention and may appear in the next research period. Health information seeking is relatively stable because of its high centrality and density value. After an internal keyword splitting and recombination, the attitudes theme is still high in centrality and density value, and the research enthusiasm has not decreased. It will continue to become a hot topic in the field of CHI research. Breast cancer split from risk in the previous study period, with increased centrality and density value (transferred from Q4 to Q1). With the expansion of research influence, it became more mature and eventually became the research core in the field. Although the number of studies related to online health information is not large, the average citation frequency of each study is the highest, indicating that it has a great influence on future research. Online health information is one of the foundations of the CHI research field, has great development potential, and may continue to appear in the next study period. Natural language processing has been a hot topic in recent years, and it is likely to continue to appear in the next study period. Health literacy is an emerging topic, with the largest number of relevant studies and total cited frequency. This indicates that it has a high level of attention and has a strong evolution and development ability. It will continue to be a hot topic in this field. Technology has been transferred from Q2 to Q4. Its research influence and development potential have improved, reflecting that it will continue to be the basic theme in this field.

By analyzing the evolution characteristics of patient education and intervention research themes, it can be found that the research in the slow growth period mainly focuses on the application and exploration of the internet and information systems and explores the health education for patients through computers and websites [ 13 ]. The research in the stable growth period mainly focuses on the use of network health information [ 41 ], the design of personalized or customized patient education [ 29 ], and the application of intelligent and mobile devices [ 30 ]. The research in the rapid growth period mainly focuses on the role and mechanism of the online health community in patient support [ 54 ], doctor–patient communication [ 63 ], and the quality evaluation of online health information [ 66 ].

By analyzing the evolution characteristics of consumer demand, attitude, and behavior research themes, it can be found that the research in the slow growth period mainly focuses on the users’ demand for online health information search, as well as demand-driven behavioral research, such as an analysis of the characteristics of health information–retrieval terms [ 28 ]. Studies in the stable growth period mainly focus on the patients’ attitude and cognition toward health information [ 23 ], health information searching behavior, and its influencing factors [ 68 ]. The research in the rapid growth period mainly focuses on personal health information management [ 69 ], health literacy assessment, and health literacy intervention [ 70 ]. The internet health information search behavior of patients with different diseases is still the research hotspot in this period.

By analyzing the evolution characteristics of the research themes regarding the internet and information technology application, it can be found that the research in the slow growth period mainly focuses on the technology applied to patient education [ 71 ] and the development of a bibliographic database network interface [ 26 ]. The studies in the stable growth period mainly focus on the use of the internet and information technology to intervene in people’s health activities [ 72 ], help improve the patients’ health status, and strengthen the patients’ self-care skills [ 73 ]. They also examined the use of information technology in the patients’ health information search behavior [ 74 ], identifying text difficulty of health information and classifying health care webpages using machine learning and natural language processing methods [ 75 , 76 ]. The research in the rapid growth period mainly focuses on the application of natural language processing [ 77 ] and the development and evaluation of user-centered mobile medical apps [ 78 ]. Wongchaisuwat et al [ 79 ] developed an algorithm to automatically answer health-related question by implementing a semisupervised learning algorithm. Park et al [ 80 ] analyzed the online discussion content of 3 online health communities employing text mining and k-means machine learning algorithm to compare the discussion topics.

Limitations

In this paper, we used the SciMAT tool to analyze the keywords of the literature data and constructed the overlapping map, evolution map, strategic diagram, and a cluster network. Owing to the limitation of the scope of our school’s database, we only obtained the literature from 1999 to 2019, failed to trace the earliest research literature on CHI, and failed to build a complete evolution path of the CHI research theme.

In this research, a bibliometric analysis was carried out to explore the dynamic evolution path and evolution laws of CHI research themes on a time dimension and from the perspective of strategic diagrams and data flows. CHI research focuses on themes, such as the patients’ education, health information needs, information search behavior, health behavior intervention, health literacy, health information technology, and eHealth. The research content in 4 different study periods formed the 38 themes. These themes formed 10 evolution paths in 3 research directions: patient education and intervention, consumer demand attitude and behavior, and internet information technology application. Patient education and intervention research, consumer demand, attitude, and behavior research comprise the main theme evolution path. The path’s evolution process has been relatively stable, and it will continue to represent the research hotspot in this field. Research on the internet and information technology application is a secondary theme evolution path, where obvious absorption, fragmentation, and extinction of themes have occurred. Its complex evolution process has also attracted the attention of many scholars. The research status and influence of this evolution path have gradually increased, making it a research direction with development potential.

According to the existing literature, themes that will continue to appear in the next study period include the following: electronic medical records , online health information , health information seeking , attitudes , health literacy , technology , and natural language processing . The first 2 themes are information resource elements in the consumer health information ecosystem. Because of the continuous advancement of medical informatization and the rapid development of social media, electronic health records, online health information, and online health question answering data have formed massive health information repositories. These health information big data are like gold mines waiting to be explored by researchers. The middle 3 themes are information subject elements, and the last 2 themes are the information technical elements in the environment. To maintain the sustainable development of the consumer health information ecosystem, it is necessary to start from the supply side and the demand side of health information and to solve the mismatch between service and demand by using computer and information technology.

Acknowledgments

We thank the State Key Program of National Social Science of China (grant no. 17AZD037) for assistance in this study. We also appreciate the support of all participants.

Abbreviations

Multimedia Appendix 1

Multimedia appendix 2.

Authors' Contributions: AL and WX co-designed this research. WO, ZX, and HH conducted the data retrieval/construction, data collection, and analysis. YY, FL, and YC helped preprocess and analyze the data. WO interpreted the results and drafted the manuscript. TW, XP, and PD made major revisions. All authors reviewed and approved the final version of the manuscript.

Conflicts of Interest: None declared.

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Americans’ Challenges with Health Care Costs

Lunna Lopes , Alex Montero , Marley Presiado , and Liz Hamel Published: Mar 01, 2024

This issue brief was updated on March 1, 2024 to include the latest KFF polling data. 

For many years, KFF polling has found that the high cost of health care is a burden on U.S. families, and that health care costs factor into decisions about insurance coverage and care seeking. These costs and the prospect of unexpected medical bills also rank as the top financial worries for adults and their families, and recent polling shows that lowering out-of-pocket health care costs is by and large the public’s top health care priority. Health care affordability is also one of the top issues that voters want to hear presidential candidates talk about during the 2024 election. This data note summarizes recent KFF polling on the public’s experiences with health care costs. Main takeaways include:

• About half of U.S. adults say it is difficult to afford health care costs, and one in four say they or a family member in their household had problems paying for health care in the past 12 months. Younger adults, those with lower incomes, adults in fair or poor health, and the uninsured are particularly likely to report problems affording health care in the past year.
• The cost of health care can lead some to put off needed care. One in four adults say that in the past 12 months they have skipped or postponed getting health care they needed because of the cost. Notably six in ten uninsured adults (61%) say they went without needed care because of the cost.
• The cost of prescription drugs prevents some people from filling prescriptions. About one in five adults (21%) say they have not filled a prescription because of the cost while a similar share say they have instead opted for over-the-counter alternatives. About one in ten adults say they have cut pills in half or skipped doses of medicine in the last year because of the cost.
• Those who are covered by health insurance are not immune to the burden of health care costs. About half (48%) of insured adults worry about affording their monthly health insurance premium and large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as “fair” or “poor” when it comes to their monthly premium and to out-of-pocket costs to see a doctor.
• Health care debt is a burden for a large share of Americans. About four in ten adults (41%) report having debt due to medical or dental bills including debts owed to credit cards, collections agencies, family and friends, banks, and other lenders to pay for their health care costs, with disproportionate shares of Black and Hispanic adults, women, parents, those with low incomes, and uninsured adults saying they have health care debt.
• Notable shares of adults still say they are worried about affording medical costs such as unexpected bills, the cost of health care services (including out-of-pocket costs not covered by insurance, such as co-pays and deductibles), prescription drug costs, and long-term care services for themselves or a family member. About three in four adults say they are either “very” or “somewhat worried” about being able to afford unexpected medical bills (74%) or the cost of health care services (73%) for themselves and their families. Additionally, about half of adults would be unable to pay an unexpected medical bill of $500 in full without going into debt.

Difficulty Affording Medical Costs

Many U.S. adults have trouble affording health care costs. While lower income and uninsured adults are the most likely to report this, those with health insurance and those with higher incomes are not immune to the high cost of medical care. About half of U.S. adults say that it is very or somewhat difficult for them to afford their health care costs (47%). Among those under age 65, uninsured adults are much more likely to say affording health care costs is difficult (85%) compared to those with health insurance coverage (47%). Additionally, at least six in ten Black adults (60%) and Hispanic adults (65%) report difficulty affording health care costs compared to about four in ten White adults (39%). Adults in households with annual incomes under $40,000 are more than three times as likely as adults in households with incomes over $90,000 to say it is difficult to afford their health care costs (69% v. 21%). (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022 )

When asked specifically about problems paying for health care in the past year, one in four adults say they or a family member in their household had problems paying for care, including three in ten adults under age 50 and those with lower household incomes (under $40,000). Affording health care is particularly a problem for those who may need it the most as one-third of adults who describe their physical health as “fair” or “poor” say they or a family member had problems paying for health care in the past 12 months. Among uninsured adults, half (49%) say they or a family member in their household had problems paying for health care, including 51% of uninsured adults who say they are in fair or poor health.

The cost of care can also lead some adults to skip or delay seeking services. One-quarter of adults say that in the past 12 months, they have skipped or postponed getting health care they needed because of the cost. The cost of care can also have disproportionate impacts among different groups of people; for instance, women are more likely than men to say they have skipped or postponed getting health care they needed because of the cost (28% vs. 21%). Adults ages 65 and older, most of whom are eligible for health care coverage through Medicare, are much less likely than younger age groups to say they have not gotten health care they needed because of cost.

One in four immigrant adults (22%) say they have skipped or postponed care in the past year, rising to about a third (36%) among those who are uninsured. Seven in ten (69%) of immigrant adults who skipped or postponed care (15% of all immigrant adults) said they did so due to cost or lack of health coverage. (Source: The 2023 KFF/LA Times Survey of Immigrants: Apr.-June 2023 )

Six in ten uninsured adults (61%) say they have skipped or postponed getting health care they needed due to cost. Health insurance, however, does not offer ironclad protection as one in five adults with insurance (21%) still report not getting health care they needed due to cost.

KFF health polling from March 2022 also looked at the specific types of care adults are most likely to report putting off and found that dental services are the most common type of medical care that people report delaying or skipping, with 35% of adults saying they have put it off in the past year due to cost. This is followed by vision services (25%), visits to a doctor’s offices (24%), mental health care (18%), hospital services (14%), and hearing services, including hearing aids (10%). (Source: KFF Health Tracking Poll: March 2022 )

A 2022 KFF report found that people who already have debt due to medical or dental care are disproportionately likely to put off or skip medical care. Half (51%) of adults currently experiencing debt due to medical or dental bills say in the past year, cost has been a probititor to getting the medical test or treatment that was recommended by a doctor. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022 )

Prescription Drug Costs

For many U.S. adults, prescription drugs are a component of their routine care. More than one in four (28%) adults say it is either “somewhat” or “very difficult” for them to afford to pay for prescription drugs. Affording prescription drugs is particularly difficult for adults who take four or more prescription medications (37%) and those in households with annual incomes under $40,000 (40%). Black and Hispanic adults are also more likely than White adults to say it is difficult for them to afford to pay for prescription drugs. (Source: KFF Health Tracking Poll: July 2023 )

The high cost of prescription drugs also leads some people to cut back on their medications in various ways. About one in five adults (21%) say in the past 12 months they have not filled a prescription because of the cost. A similar share (21%) say they have taken an over-the-counter drug instead of getting a prescription filled – rising to about one third of Hispanic adults (32%) and more than one in four adults (27%) with annual household incomes under $40,000. About one in ten adults say that in the past 12 months they have cut pills in half or skipped doses of medicine due to cost. (Source: KFF Health Tracking Poll: July 2023 )

Health Insurance Cost Ratings

Overall, most insured adults rate their health insurance as “excellent” or “good” when it comes to the amount they have to pay out-of-pocket for their prescriptions (61%), the amount they have to pay out-of-pocket to see a doctor (53%), and the amount they pay monthly for insurance (54%). However, at least three in ten rate their insurance as “fair” or “poor” on each of these metrics, and affordability ratings vary depending on the type of coverage people have.

Adults who have private insurance through employer-sponsored insurance or Marketplace coverage are more likely than those with Medicare or Medicaid to rate their insurance negatively when it comes to their monthly premium, the amount they have to pay out of pocket to see a doctor, and their prescription co-pays. About one in four adults with Medicare give negative ratings to the amount they have to pay each month for insurance and to their out-of-pocket prescription costs, while about one in five give their insurance a negative rating when it comes to their out-of-pocket costs to see a doctor.

Medicaid enrollees are less likely than those with other coverage types to give their insurance negative ratings on these affordability measures (Medicaid does not charge monthly premiums in most states, and copays for covered services, where applied, are required to be nominal.) (Source: KFF Survey of Consumer Experiences with Health Insurance )

Health Care Debt

In June 2022, KFF released an analysis of the KFF Health Care Debt Survey , a companion report to the investigative journalism project on health care debt conducted by KFF Health News and NPR, Diagnosis Debt . This project found that health care debt is a wide-reaching problem in the United States and that 41% of U.S. adults currently have some type of debt due to medical or dental bills from their own or someone else’s care, including about a quarter of adults (24%) who say they have medical or dental bills that are past due or that they are unable to pay, and one in five (21%) who have bills they are paying off over time directly to a provider. One in six (17%) report debt owed to a bank, collection agency, or other lender from loans taken out to pay for medical or dental bills, while similar shares say they have health care debt from bills they put on a credit card and are paying off over time (17%). One in ten report debt owed to a family member or friend from money they borrowed to pay off medical or dental bills.

While four in ten U.S. adults have some type of health care debt, disproportionate shares of lower income adults, the uninsured, Black and Hispanic adults, women, and parents report current debt due to medical or dental bills.

Vulnerabilities and Worries About Health Care and Long-Term Care Costs

A February 2024 KFF Health Tracking Poll shows unexpected medical bills and the cost of health care services are at the top of the list of people’s financial worries, with about three-quarters of the public – and similar shares of insured adults younger than 65 – saying they are at least somewhat worried about affording unexpected medical bills (74%) or the cost of health care services (73%) for themselves and their families. Just over half (55%) of the public say they are “very” or “somewhat worried” about being able to afford their prescription drug costs, while about half (48%) of insured adults say they are worried about affording their monthly health insurance premium.

Worries about health care costs pervade among a majority of adults regardless of their financial situation . Among adults who report difficulty affording their monthly bills, more than eight in ten say they are worried about the cost of health care services (86%) or unexpected medical bills (83%). Among those who report being just able to afford their bills, about eight in ten say they are worried about being able to afford unexpected medical bills (84%) or health care services (83%). And even among adults who say they can afford their bills with money left over, six in ten nonetheless say they are “very” or “somewhat worried” about being able to afford unexpected medical bills (62%) or the cost of health care services (60%) for themselves and their family. (Source: KFF Health Tracking Poll: February 2024 )

Many U.S. adults may be one unexpected medical bill from falling into debt. About half of U.S. adults say they would not be able to pay an unexpected medical bill that came to $500 out of pocket. This includes one in five (19%) who would not be able to pay it at all, 5% who would borrow the money from a bank, payday lender, friends or family to cover the cost, and one in five (21%) who would incur credit card debt in order to pay the bill. Women, those with lower household incomes, Black and Hispanic adults are more likely than their counterparts to say they would be unable to afford this type of bill. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022 )

Among older adults, the costs of long-term care and support services are also a concern. Almost six in ten (57%) adults 65 and older say they are at least “somewhat anxious” about affording the cost of a nursing home or assisted living facility if they needed it, and half say they feel anxious about being able to afford support services such as paid nurses or aides. These concerns also loom large among those between the ages of 50 and 64, with more than seven in ten saying they feel anxious about affording residential care (73%) and care from paid nurses or aides (72%) if they were to need these services. See The Affordability of Long-Term Care and Support Services: Findings from a KFF Survey for a deeper dive into concerns about the affordability of nursing homes and support services.

• Health Costs
• Racial Equity and Health Policy
• Private Insurance
• Affordability
• High Deductible Plans
• Tracking Poll
• Survey on Racism, Discrimination and Health

Also of Interest

• Survey on Racism, Discrimination and Health Project
• Health Care Debt In The U.S.: The Broad Consequences Of Medical And Dental Bills
• KFF Health Tracking Poll – March 2022: Economic Concerns and Health Policy, The ACA, and Views of Long-term Care Facilities
• KFF’s Kaiser Health News and NPR Launch Diagnosis: Debt, a Yearlong Reporting Partnership Exploring the Scale, Impact, and Causes of the Health Care Debt Crisis in America
• How Financially Vulnerable are People with Medical Debt?

• U.S. Department of Health & Human Services HHS
• National Institutes of Health NIH
• Division of Program Coordination, Planning, and Strategic Initiatives DPCPSI

Dietary Supplements: What You Need to Know

Many adults and children in the United States take one or more vitamins or other dietary supplements . In addition to vitamins, dietary supplements can contain minerals , herbs or other botanicals , amino acids , enzymes , and many other ingredients . Dietary supplements come in a variety of forms, including tablets, capsules , gummies, and powders as well as drinks and energy bars. Popular supplements include vitamins D and B12; minerals like calcium and iron ; herbs such as echinacea and garlic; and products like glucosamine , probiotics, and fish oils.

The Dietary Supplement Label

Products sold as dietary supplements come with a Supplement Facts label that lists the active ingredients, the amount per serving ( dose ), and other ingredients, such as fillers , binders , and flavorings. The manufacturer suggests the serving size, but your health care provider might decide a different amount is more appropriate for you.

Effectiveness

Some dietary supplements can improve overall health and help manage some health conditions. For example: 

• Calcium and vitamin D help keep bones strong and reduce bone loss. 
• Folic acid decreases the risk of certain birth defects.
• Omega-3 fatty acids from fish oils might help some people with heart disease. 
• A combination of vitamins C and E, zinc , copper , lutein , and zeaxanthin (known as an Age-Related Eye Disease Study [AREDS] formula) may slow down further vision loss in people with age-related macular degeneration (AMD). 

Many other supplements need more study to determine if they have value. The U.S. Food and Drug Administration (FDA) does not determine whether dietary supplements are effective before they are marketed.

Safety and Risk

Many supplements contain active ingredients that can have strong effects on the body. Always be alert to the possibility of a bad reaction, especially when taking a new product.

You are most likely to have side effects from dietary supplements if you take them at high doses, or instead of prescribed medicines, or if you take many different supplements. Some supplements can increase the risk of bleeding or, if taken before surgery, can change your response to anesthesia. Supplements can also interact with some medicines in ways that might cause problems. Here are a few examples:

• Vitamin K can reduce the ability of the blood thinner warfarin to prevent blood from clotting.
• St. John’s wort can speed the breakdown of many medicines and reduce their effectiveness (including some antidepressants, birth control pills, heart medications, anti-HIV medications, and transplant drugs ).
• Antioxidant supplements, such as vitamins C and E, might reduce the effectiveness of some types of cancer chemotherapy .

Manufacturers may add vitamins, minerals, and other supplement ingredients to foods you eat, especially breakfast cereals and beverages. As a result, you may get more of these ingredients than you think, and more might not be better. Taking more than you need costs more and might also raise your risk of side effects. For example, too much vitamin A can cause headaches and liver damage, reduce bone strength, and cause birth defects. Excess iron causes nausea and vomiting and may damage the liver and other organs.

Be cautious about taking dietary supplements, beyond a standard prenatal supplement, if you are pregnant or nursing . Also, be careful about giving supplements to a child, unless recommended by their health care provider. Many supplements have not been well tested for safety in children and in those who are pregnant or nursing.

FDA has established Good Manufacturing Practices (GMPs) that companies must follow to help ensure the identity, purity, strength, and composition of their dietary supplements. These GMPs can prevent adding the wrong ingredient (or too much or too little of the correct ingredient) and reduce the chance of contamination or improper packaging and labeling of a product. FDA periodically inspects facilities that manufacture supplements.

Several independent organizations offer quality testing and allow products that pass these tests to display a seal of quality assurance that indicates the product was properly manufactured, contains the ingredients listed on the label, and does not contain harmful levels of contaminants. These seals do not guarantee that a product is safe or effective. Organizations that offer quality testing include:*

• ConsumerLab.com
• NSF International
• U.S. Pharmacopeia

      * Any mention of a specific company, organization, or service does not represent an endorsement by ODS .

Talk with Your Health Care Providers

Tell your health care providers (including doctors, dentists,  pharmacists , and dietitians) about any dietary supplements you’re taking. They can help you determine which supplements, if any, might be valuable for you.

Keep a complete record of any dietary supplements and medicines you take. The Office of Dietary Supplements website has a useful form, My Dietary Supplement and Medicine Record , that you can print and fill out at home. For each product, note the name, the dose you take, how often you take it, and the reason for use. You can share this record with your health care providers to discuss what’s best for your overall health. 

Keep in Mind

• Consult your health care provider before taking dietary supplements to treat a health condition.
• Get your health care provider’s approval before taking dietary supplements in place of, or in combination with, prescribed medicines.
• If you are scheduled to have any type of surgical procedure, talk with your health care provider about any supplements you take. 
• Keep in mind the term natural doesn’t always mean safe. Some all-natural botanical products, for example comfrey and kava , can harm the liver. A dietary supplement’s safety depends on many things, such as its chemical makeup, how it works in the body, how it is prepared, and the amount you take. 
• What are its potential benefits for me?
• Does it have any safety risks?
• What is the proper dose to take?
• How, when, and for how long should I take it? 

Federal Regulation of Dietary Supplements

Dietary supplements are products intended to supplement the diet. They are not medicines and are not intended to treat, diagnose , mitigate , prevent, or cure diseases. FDA is the federal agency that oversees both supplements and medicines, but FDA regulations for dietary supplements are different from those for prescription or over-the-counter medicines.

Medicines must be approved by FDA before they can be sold or marketed. Supplements do not require this approval. Supplement companies are responsible for having evidence that their products are safe, and the label claims are truthful and not misleading. However, as long as the product does not contain a new dietary ingredient (one introduced since October 15, 1994), the company does not have to provide this safety evidence to FDA before the product is marketed.

Dietary supplement labels may include certain types of health-related claims. Manufacturers are permitted to say, for example, that a supplement promotes health or supports a body part or function (like heart health or the immune system). These claims must be followed by the words, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Manufacturers must follow GMPs to ensure the identity, purity, strength, and composition of their products. If FDA finds a dietary supplement to be unsafe, it may remove the product from the marketplace or ask the manufacturer to voluntarily recall the product.

FDA monitors the marketplace for potential illegal products that may be unsafe or make false or misleading claims. The Federal Trade Commission , which monitors product advertising, also requires information about a supplement product to be truthful and not misleading.

The federal government can take legal action against companies and websites that sell dietary supplements when the companies make false or deceptive statements about their products, if they promote them as treatments or cures for diseases, or if their products are unsafe.

Federal Government Information Sources on Dietary Supplements

National institutes of health.

National Institutes of Health ( NIH ) supports research and provides educational materials on dietary supplements.

• Office of Dietary Supplements (ODS) ODS provides accurate and up-to-date scientific information about dietary supplements.
• National Center for Complementary and Integrative Health (NCCIH) NCCIH also has scientific information about dietary supplement ingredients.
• NIH Health Information   Information about healthy living and wellness from across NIH.

U.S. Food and Drug Administration 

Federal trade commission (ftc), u.s. department of agriculture (usda), u.s. department of health and human services (hhs).

This fact sheet by the National Institutes of Health (NIH) Office of Dietary Supplements (ODS) provides information that should not take the place of medical advice. We encourage you to talk to your health care providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice.

Updated: January 4, 2023 History of changes to this fact sheet

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FDA 101: Dietary Supplements

Dietary supplements can help improve health but can also have risks. Get the facts on supplements and how the FDA regulates them to help keep you safe.

Multivitamins, vitamin D, echinacea, and fish oil are among the many dietary supplements lining store shelves or available online. Perhaps you already take a supplement or are thinking about using one. Dietary supplements can be beneficial to your health, but they can also involve health risks. So, it’s important that you talk with a health care professional to help you decide if a supplement is right for you.

Read on to learn what dietary supplements are (and are not), what role the U.S. Food and Drug Administration has in regulating them, and how to make sure you and your family use supplements safely.

What Are Dietary Supplements?

Dietary supplements are intended to add to or supplement the diet and are different from conventional food. Generally, to the extent a product is intended to treat, diagnose, cure, or prevent diseases, it is a drug, even if it is labeled as a dietary supplement. Supplements are ingested and come in many forms, including tablets, capsules, soft gels, gel caps, powders, bars, gummies, and liquids.

Common supplements include:

• Vitamins (such as multivitamins or individual vitamins like vitamin D and biotin).
• Minerals (such as calcium, magnesium, and iron).
• Botanicals or herbs (such as echinacea and ginger).
• Botanical compounds (such as caffeine and curcumin).
• Amino acids (such as tryptophan and glutamine).
• Live microbials (commonly referred to as “probiotics”).

What Are the Benefits of Dietary Supplements?

Dietary supplements can help you improve or maintain your overall health, and supplements can also help you meet your daily requirements of essential nutrients.

For example, calcium and vitamin D can help build strong bones, and fiber can help to maintain bowel regularity. While the benefits of some supplements are well established, other supplements need more study. Also, keep in mind that supplements should not take the place of the variety of foods that are important for a healthy diet.

What Are the Risks of Dietary Supplements?

Before buying or taking a dietary supplement, talk with a health care professional—such as your doctor, nurse, registered dietician, or pharmacist—about the benefits and risks.

Many supplements contain ingredients that can have strong effects in the body. Additionally, some supplements can interact with medications, interfere with lab tests, or have dangerous effects during surgery. Your health care professional can help you decide what supplement, if any, is right for you.

When taking dietary supplements, be alert to the possibility of a bad reaction or side effect (also known as an adverse event).

Problems can occur especially if you:

• Combine supplements.
• Mix medicines and supplements .
• Take too much of some supplements.
• Take supplements instead of medications.

If you experience an adverse event while taking a dietary supplement, immediately stop using the supplement, seek medical care or advice, and report the adverse event to the FDA .

How Are Dietary Supplements Regulated?

The Federal Food, Drug, and Cosmetic Act (FD&C Act) was amended in 1994 by the Dietary Supplement Health and Education Act (often referred to as DSHEA), which defined “dietary supplement” and set out FDA’s authority regarding such products. Under existing law:

• The FDA does NOT have the authority to approve dietary supplements for safety and effectiveness, or to approve their labeling, before the supplements are sold to the public.
• Under the FD&C Act, it is the responsibility of dietary supplement companies to ensure their products meet the safety standards for dietary supplements and are not otherwise in violation of the law.
• Dietary supplement labels are required to have nutrition information in the form of a Supplement Facts label that includes the serving size, the number of servings per container, a listing of all dietary ingredients in the product, and the amount per serving of those ingredients. They also must have a statement on the front of the product identifying it as a “dietary supplement” or similar descriptive term (e.g., “herbal supplement” or “calcium supplement”). 

In general, even if a product is labeled as a dietary supplement, a product intended to treat, prevent, cure, or alleviate the symptoms of a disease is a drug, and subject to all requirements that apply to drugs.

The FDA’s Role and Actions to Help Keep You Safe

Even though the FDA does not approve dietary supplements, there are roles for the agency in regulating them.

• Since companies can often introduce a dietary supplement to the market without notifying the FDA, the agency's role in regulating supplements primarily begins after the product enters the marketplace.
• The FDA periodically inspects dietary supplement manufacturing facilities to verify companies are meeting applicable manufacturing and labeling requirements.
• The FDA also reviews product labels and other labeling information, including websites, to ensure products are appropriately labeled and that they do not include claims that may render the products drugs (e.g., claims to treat, diagnose, cure, or prevent diseases).
• The FDA monitors adverse event reports submitted by dietary supplement companies, health care professionals, and consumers as well as other product complaints for valuable information about the safety of products once they are on the market.
• Work with the company to bring the product into compliance.
• Ask the company to voluntarily recall the product.
• Take action to remove a dangerous product from the market.

Tips to Be a Safe and Informed Consumer

Before taking a dietary supplement, talk with your health care professional. They can help you decide which supplements, if any, are right for you. You can also contact the manufacturer for information about the product.

• Take only as described on the label. Some ingredients and products can be harmful when consumed in high amounts, when taken for a long time, or when used in combination with certain drugs or foods.
• Do not substitute a dietary supplement for a prescription medicine or for the variety of foods important to a healthy diet.
• Do not assume that the term "natural" to describe a product ensures that it is safe.
• Be wary of hype. Sound health advice is generally based upon research over time, not a single study.
• Learn to spot false claims. If something sounds too good to be true, it probably is.

Why Is It Important to Report an Adverse Event?

If you experience adverse event, also known as a side effect or bad reaction, the FDA encourages both you and your health care professional to report the adverse event to the FDA.

You can help the FDA, yourself, and other consumers by reporting an adverse event. A single adverse event report can help us identify a potentially dangerous product and possibly remove it from the market.

For a list of potential serious reactions to watch for, and to learn how to report an adverse event, please see the FDA’s webpage,  How to Report a Problem with Dietary Supplements .

Adverse events can also be reported to the product's manufacturer or distributor through the address or phone number listed on the product's label. Dietary supplement firms are required to report serious adverse events they receive about their dietary supplements to FDA within 15 days.

For a general, nonserious complaint or concern about dietary supplements, contact your local FDA Consumer Complaint Coordinator .

Additional Resources:

• Dietary Supplements , FDA
• Information for Consumers on Using Dietary Supplements , FDA
• Dietary Supplement Fact Sheets , National Institutes of Health

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40 Facts About Elektrostal

Written by Lanette Mayes

Modified & Updated: 01 Jun 2024

Reviewed by Jessica Corbett

Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.

This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.

So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.

Key Takeaways:

• Elektrostal, known as the “Motor City of Russia,” is a vibrant and growing city with a rich industrial history, offering diverse cultural experiences and a strong commitment to environmental sustainability.
• With its convenient location near Moscow, Elektrostal provides a picturesque landscape, vibrant nightlife, and a range of recreational activities, making it an ideal destination for residents and visitors alike.

Known as the “Motor City of Russia.”

Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.

Home to the Elektrostal Metallurgical Plant.

Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.

Boasts a rich industrial heritage.

Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.

Founded in 1916.

The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.

Located approximately 50 kilometers east of Moscow.

Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.

Known for its vibrant cultural scene.

Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.

A popular destination for nature lovers.

Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.

Hosts the annual Elektrostal City Day celebrations.

Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.

Has a population of approximately 160,000 people.

Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.

Boasts excellent education facilities.

The city is known for its well-established educational institutions, providing quality education to students of all ages.

A center for scientific research and innovation.

Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy , materials science, and engineering.

Surrounded by picturesque lakes.

The city is blessed with numerous beautiful lakes , offering scenic views and recreational opportunities for locals and visitors alike.

Well-connected transportation system.

Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.

Famous for its traditional Russian cuisine.

Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.

Home to notable architectural landmarks.

Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.

Offers a wide range of recreational facilities.

Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.

Provides a high standard of healthcare.

Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.

Home to the Elektrostal History Museum.

The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.

A hub for sports enthusiasts.

Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.

Celebrates diverse cultural festivals.

Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.

Electric power played a significant role in its early development.

Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.

Boasts a thriving economy.

The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.

Houses the Elektrostal Drama Theater.

The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.

Popular destination for winter sports.

Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.

Promotes environmental sustainability.

Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.

Home to renowned educational institutions.

Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.

Committed to cultural preservation.

The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.

Hosts an annual International Film Festival.

The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.

Encourages entrepreneurship and innovation.

Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development .

Offers a range of housing options.

Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.

Home to notable sports teams.

Elektrostal is proud of its sports legacy , with several successful sports teams competing at regional and national levels.

Boasts a vibrant nightlife scene.

Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.

Promotes cultural exchange and international relations.

Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

Surrounded by beautiful nature reserves.

Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.

Commemorates historical events.

The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.

Promotes sports and youth development.

Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.

Hosts annual cultural and artistic festivals.

Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.

Provides a picturesque landscape for photography enthusiasts.

The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.

Connects to Moscow via a direct train line.

The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.

A city with a bright future.

Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.

In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.

Q: What is the population of Elektrostal?

A: As of the latest data, the population of Elektrostal is approximately XXXX.

Q: How far is Elektrostal from Moscow?

A: Elektrostal is located approximately XX kilometers away from Moscow.

Q: Are there any famous landmarks in Elektrostal?

A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.

Q: What industries are prominent in Elektrostal?

A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.

Q: Are there any universities or educational institutions in Elektrostal?

A: Yes, Elektrostal is home to XXXX University and several other educational institutions.

Q: What are some popular outdoor activities in Elektrostal?

A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.

Q: Is Elektrostal well-connected in terms of transportation?

A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.

Q: Are there any annual events or festivals in Elektrostal?

A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.

Elektrostal's fascinating history, vibrant culture, and promising future make it a city worth exploring. For more captivating facts about cities around the world, discover the unique characteristics that define each city . Uncover the hidden gems of Moscow Oblast through our in-depth look at Kolomna. Lastly, dive into the rich industrial heritage of Teesside, a thriving industrial center with its own story to tell.

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John Deere Officially Opens New Manufacturing Facility in Russia

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Apr 27, 2010, 09:00 ET

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MOSCOW , April 27 /PRNewswire-FirstCall/ -- Deere & Company (NYSE: DE ) officially opened its new manufacturing and parts distribution facility south of Moscow today in Domodedovo. The John Deere Domodedovo facility is the company's largest single investment to date in Russia . The facility will manufacture agricultural, construction and forestry machinery as well as distribute service parts in the region.

(Logo: http://www.newscom.com/cgi-bin/prnh/20030326/JOHNDEERELOGO )

" Russia has a tradition of embracing advanced equipment and modern agricultural and forestry management practices," said Deere & Company chairman and CEO Samuel R. Allen at the facility's grand opening ceremony. "These are critical to the health and development of large-scale farming and forestry. They also tend to be a good match for the capabilities of John Deere products."

The new facility at Domodedovo is open just nine months after John Deere first announced its plans at the Russia - U.S. Business Forum last summer. Deere received strong cooperation from the Russian Federal government, the Moscow Oblast, and the community of Domodedovo to open the factory within this short time frame.

Allen noted that most of the world's available arable land is already being farmed, that clean water is becoming increasingly scarce, and that infrastructure is needed in many parts of the world to bring crops and forestry materials to market.

" Russia has great advantages in all these areas and the potential to become one of the world's major food-producing regions," Allen said.

At the opening ceremony for the John Deere facility, Allen said Russia 's future holds "truly immense potential as a major provider of the renewable resources so vital to the world's economic and social well-being."

He added that Deere's future plans in Russia are supportive of the Russian government's objectives to boost the output of grains and other renewable resources and to make the farm and forestry sectors more commercially vibrant.

Deere has said that the new Domodedovo facility will include a new EurAsia Parts Distribution Center and manufacture products for the company's two major divisions, including large tractors and combines for use in agriculture and a series of products for use in construction and forestry. Both the parts distribution and manufacturing capabilities will help John Deere serve customers in Russia and throughout the Commonwealth of Independent States and in other nearby markets.

In his remarks at the grand opening, Allen said, Deere first sold products in Russia 100 years ago. Now, he said, in addition to the new Domodedovo location, John Deere has a manufacturing site in Orenburg, offices in St. Petersburg and Moscow and over 70 sales and service locations located in Russia .

John Deere is a world leader in providing advanced products and services for agriculture, forestry, construction, lawn and turf care, landscaping and irrigation. John Deere also provides financial services worldwide and manufactures and markets engines used in heavy equipment. Since it was founded in 1837, the company has extended its heritage of integrity, quality, commitment and innovation around the globe.

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Also from this source, deere & company raises quarterly dividend.

The Deere & Company (NYSE: DE) Board of Directors today declared a quarterly dividend of $1.35 per share payable November 8, 2023 to stockholders of...

Deere Reports Third Quarter Net Income of $2.978 Billion

Deere & Company (NYSE: DE) reported net income of $2.978 billion for the third quarter ended July 30, 2023, or $10.20 per share, compared with net...

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Debunking common myths about healthcare consumerism

Until recently, consumerism in the U.S. healthcare industry has moved slowly. However, several converging forces are likely to change the situation soon and result in a more dynamic market. Higher deductibles and copayments, greater transparency into provider performance and costs, and the rise of network narrowing and provider-led health plans are prodding patients to become more involved in healthcare decision making than ever before.

As yet, most payors and providers have comparatively little data to assess how consumerism is likely to affect them. As a consequence, they can neither confirm nor refute a number of assumptions about healthcare consumerism that are often stated as fact.

Over the past eight years, we have conducted extensive research into healthcare consumerism. This year alone, we surveyed more than 11,000 people across the country about how they perceive their healthcare needs and wants, how they select providers, and how they make other healthcare decisions. Our results suggest that many of the assumptions currently being made about healthcare consumerism are no more than myths.

Appendix: Details about our research

The articles in this compendium leverage proprietary research and analyses that McKinsey’s Healthcare Systems and Services Practice, McKinsey Advanced Healthcare Analytics, and other groups within the firm have conducted over the past several years. This appendix describes the major tools and data sources used in these articles.

Consumer Health Insights (CHI) Survey

This unique annual survey, which has been conducted since 2007, provides information on the opinions, preferences, and behaviors of healthcare consumers, as well as the environmental factors that influence their healthcare choices. The survey also enables insights into the current market environment and can be used to make predictions about the choices and tradeoffs consumers are likely to make in the post-reform environment. The CHI survey collects descriptive information on all participants and their households.

In addition, it assesses a range of variables, including: A) respondents’ shopping behaviors; B) their attitudes regarding health, healthcare, and the purchase and use of healthcare services; C) their awareness of health reform; D) their opinions about shopping for health insurance and using an insurance exchange; E) their preferences for specific plan designs (including tradeoffs among coverage features, such as benefits, network, ancillaries, service options, cost sharing, brand, and price); F) their perceptions of the employer’s role in healthcare coverage; G) their attitudes about a broad range of related supplemental insurance products; H) their opinions, use, and loyalty levels regarding healthcare providers; and I) their attitudes and behaviors regarding pharmaceuticals and pharmacies.

The CHI survey included a total of 2,255 participants in 2015, 4,019 in 2014, and 6,934 in 2013.

Medicaid Consumer Survey

Quantitative consumer insights about the current Medicaid population and potential new entrants to the program have been difficult to come by. To help address this gap, McKinsey surveyed more than 1,419 consumers across the United States in 2015, focusing on current Medicaid members (both dual eligibles and non-dual enrollees) and people who are currently eligible for Medicaid but not enrolled. The results, weighted to reflect the age, gender, ethnicity, education, and income of each of the groups, revealed important insights about the current and future Medicaid population.

Medicare Consumer Survey

Our Medicare consumer survey was a national survey of 2,208 seniors who are covered by Medicare Advantage, Medicare fee-for-service, or Medicare supplement plans. The survey sought to understand what matters to these consumers and their decision-making process for both coverage- and care-related decisions.

Post-open enrollment period survey

McKinsey’s post-open enrollment period survey is a national survey of 3,007 uninsured and individually insured consumers. It was conducted February 21–24, 2015, shortly after the 2015 individual market open enrollment period (OEP) ended. This survey is part of the ongoing longitudinal research we began with four 2014 OEP surveys (which together had about 14,000 respondents), which were conducted between November 2013 and February 2014, enabling trend analysis.

Private exchange simulation

McKinsey’s private exchange simulation investigates what might happen if individuals currently covered under employer-sponsored insurance were given the option of selecting their own coverage (and other benefits) on a private online exchange. It assesses participants’ interest in private exchanges and tests their buying behavior given a range of plan options and ancillary benefits. In the past year, more than 2,400 consumers have participated in these online simulations.

Healthcare is different from other industries. Consumers don’t bring the same expectations about customer experience to healthcare that they bring to retail or technology companies.

Our findings indicate that consumers want the same qualities in healthcare companies that they value in non-healthcare settings. In this year’s Consumer Health Insights (CHI) survey, we asked participants to identify the non-healthcare companies with the strongest consumer focus. Apple and Amazon led the list. We then asked the participants to tell us what qualities gave such companies a strong customer focus, as well as what they valued in a consumer-focused healthcare company.

The answers to the two questions were surprisingly similar (Exhibit 1). For example, more than half the participants cited great customer service as important for nonhealthcare and healthcare companies alike. Other qualities that the participants identified as important for both sets of companies were delivering on expectations, making life easier, and offering great value.

Whether healthcare companies need to perform as well as Apple and Amazon on customer experience remains to be seen. However, the evidence suggests that just performing better than other current healthcare competitors will not be sufficient. Customer expectations are being set by non-healthcare industries, and meeting those expectations is likely to be critical to ensure satisfaction and loyalty.

Consumers know what they want from healthcare companies and what drives their decisions.

Most consumers have strong opinions about what matters to them when they make healthcare decisions or receive healthcare services. The evidence suggests, however, that there is often a disconnect between what consumers believe matters most and what influences their opinions most strongly. Given the intangible nature of health insurance and healthcare provision, it appears that some factors play a much greater role than most consumers realize. For example, as part of our 2014 CHI survey, we posed two questions about patient satisfaction to the participants who reported having been hospitalized within the previous three years. First, we asked them how satisfied they were with their hospital experience. Second, we asked them to rank the importance of various factors that might have influenced their satisfaction levels.

More than 90% of these participants said they had been at least somewhat satisfied with the care they received, and most of them rated the outcome achieved as the most important influence on their satisfaction. However, when we mapped the factors that participants said influenced their satisfaction against their reported levels of satisfaction, we found that the empathy and support provided by health professionals (especially nurses) had a stronger impact than outcomes did (Exhibit 2). Satisfaction levels were also strongly influenced by the information the participants had been given during and after treatment.

In general, our results suggest that people tend to overstate tangible factors (e.g., parking, pain management) and understate factors that are more emotional (e.g., empathy) or abstract (e.g., value).

Most consumers research their healthcare choices before making important decisions and then make fact-based choices based on their research.

Five different surveys we conducted recently suggest that many, if not most, healthcare consumers are not yet making research-based decisions. Our findings indicate, for example, that only a few consumers are currently researching provider costs or even the number of providers they can choose among. Although some (but far from most) consumers are beginning to research their health plan choices, many of them are not yet aware of key factors they should consider before selecting coverage.

Would you like to learn more about our Healthcare Systems & Services Practice ?

Provider choices. In this year’s CHI survey, only 22% of the participants said that they always ask about cost before going to a doctor or other healthcare provider. We also asked participants whether they had received certain services in the past year and, if so, whether they had researched costs in advance. Exhibit 3 shows the results. The participants who received maternity care were most likely to report that they had researched costs prospectively. In all cases, the participants were much more likely to say that they had “talked to someone” (e.g., a provider or insurance representative) to investigate costs than to look at websites. Furthermore, even among the subset of consumers who reported doing research on costs before undergoing an expensive, invasive procedure (e.g., cardiac or joint surgery), half still said that their doctor’s recommendation was the key factor that influenced their decision about where to seek care.

Cost is not the only factor most consumers are not yet actively investigating. In last year’s CHI survey, we asked the participants who reported having been hospitalized in the previous three years to tell us how many hospitals there were in their local area. More than half said there was only one local hospital when, in fact, there were a median of three hospitals within a 10-mile radius of their home and ten hospitals within a 20-mile radius.

Health plan choices. Soon after the close of the 2015 open enrollment period (OEP), we surveyed consumers who were eligible to purchase exchange plans to investigate the decisions they made about health insurance during the OEP. 1 1. Noam Bauman et al., “ Hospital networks: Evolution of the configurations on the 2015 exchanges ,” McKinsey Center for US Health System Reform intelligence brief, McKinsey on Healthcare , April 2015. Forty-four percent of those who said they have bought an exchange plan for the first time indicated that they did not understand the type of provider network included in their plan. Nineteen percent of those who had purchased an exchange plan last year also indicated they were unaware of their plan’s provider network. Only 12% of those who remained uninsured knew the size of the subsidy they were eligible for, and only 59% were aware of the penalty for not obtaining coverage.

Similarly, in our survey this year of Medicare members, we found that only 21% of those who had enrolled in a Medicare Advantage (MA) plan knew their plan’s Star rating. However, almost all of those who knew their plan’s rating had purchased a plan that had three or more stars.

Moreover, in a survey we conducted this year of Medicaid-eligible recipients, only 32% of those who were enrolled in a managed care program and did not have dual Medicare coverage indicated that they had done any research before selecting a carrier, even though they had the option of choosing among multiple carriers.

Now that consumers are paying more for their healthcare, premium price is the only truly important factor in purchase decisions.

During both the 2014 and 2015 OEPs, premium price was, indeed, an important factor for many consumers. However, a sizeable percentage of people did not buy the cheapest plan available to them.

In our 2015 post-OEP survey, for example, 49% of the participants who had purchased exchange plans and remembered the plans’ pricing said that they had selected products with premiums that were average or above-average relative to the other plans within the comparable metal tier. The higher-premium products these participants bought (in comparison with the less-expensive plans purchased by other respondents) were more likely to be based on preferred provider organizations, to include pharmacy benefit add-ons, or to cover alternative types of care (e.g., acupuncture, chiropractic).

A subsequent report released by the Department of Health and Human Services confirms that price is not the only factor that many people shopping for individual coverage consider. 2 2. For more, see Health insurance marketplaces 2015 open enrollment period: March enrollment report , ASPE issue brief, March 10, 2015, aspe.hss.gov. It found that 66% of the 8.84 million people who bought health insurance through the federally facilitated marketplace during the 2015 OEP could have purchased a health plan with a monthly premium of $50 or less (after the advanced premium tax credit was applied). However, only about half of these people bought the very-low-cost plans.

In our Medicare study, we asked participants to design their own plan, giving them trade-offs between premium prices and various cost-sharing and benefit options (e.g., premiums went up as deductibles went down). Only 15% of the participants selected a $0 premium plan. In contrast, almost two-thirds of them said they would be willing to pay a $50 premium per month if it would reduce their medical deductible to $0. Thirty percent of the participants said that they would be willing to pay more than they were currently paying if it would help them hold their deductible down or enabled them to buy ancillary products. The feature cited most often by those willing to pay higher premiums was having a $0 deductible for prescription drugs.

Similarly, in this year’s CHI survey, one-third of the participants said they were willing or very willing to pay up to 20% more for health insurance if it gave them more choices about where to seek care. Furthermore, in a private exchange simulation we conducted recently with individuals covered by employer-sponsored insurance, the participants spent, on average, 40% above the employer contribution level to obtain ancillary benefits, such as vision, life, and critical illness insurance. In fact, many of the private exchange simulation participants were willing to trade down on medical benefits so they could trade up on ancillary benefits (Exhibit 4).

Almost all consumers have a primary care provider (PCP) and are highly reluctant to change doctors.

In this year’s CHI survey, 82% of participants said that they had a regular PCP. However, the likelihood of having a PCP was age-related: 96% of the participants above age 65 reported having a PCP, compared with only 65% of those ages 18 to 34. The likelihood of having a PCP was also influenced by income (89% of those with incomes above $100,000 said that they had a PCP) and health status (90% of those with one or more chronic conditions had a PCP).

Among all of the participants who did have a regular PCP, 66% said that they would not change providers unless they or their doctor moved. However, 57% of them also indicated that they would be willing to switch doctors if their health plan no longer covered their PCP. Among this 57%, willingness to switch was influenced by the length of a participant’s relationship with the PCP: 72% of those who had been using that doctor for only one or two years were willing to make the change, compared with 53% of those who had been with their doctor for five or more years.

Other evidence from this year’s CHI suggests that many consumers are willing to consult providers other than a regular PCP. For example, 71% of all of the participants agreed with the statement: “There are many good primary care physicians that I would be satisfied seeing.” Forty-five percent of the participants said that they had made an appointment at least once with any available doctor within the same practice or facility as their regular PCP. Of those who had not done so, only 18% indicated that they were unwilling to consult any doctor but their PCP.

In addition, 16% of the participants said that they receive routine care from a multidoctor primary care clinic rather than an individual PCP. When asked why, nearly half of these participants cited accessibility (e.g., convenient locations, shorter waiting times, easier scheduling). Among the 84% of participants who did not receive care from a primary care clinic, 55% said they would be willing to do so if it cost no more than or less than what they currently pay (Exhibit 5).

Retail clinics will remain a niche health solution.

Awareness and utilization of other alternative-care options are also rising. In this year’s CHI survey, more than 80% of the participants were aware of healthcare services being offered through pharmacies and retail stores. About half of these participants, however, were unsure of the specific services being offered.

About two-thirds of the participants said they are willing to use healthcare services offered by a pharmacy or retail store. Twenty percent reported having already sought care in these settings within the past two years (up from 10% in our 2013 CHI survey). The chief reason given for using pharmacies and retail clinics for care was, once again, accessibility (convenient locations, not needing an appointment, convenient hours). More than three-quarters of the 2015 participants who had used these alternative-care options said they plan to do so again.

Just over half (51%) of those who reported having received healthcare services at a pharmacy or retail clinic indicated that they had done so for immunizations; 26% said they had sought treatment for a minor illness. Of the participants who said they had not yet used one of these alternative-care options, more than 60% indicated they were willing to do so for immunizations, minor illnesses, or nutritional/weight loss support (Exhibit 6).

Use of these alternative care options could grow substantially in the next few years, given their increasing numbers and expanding offerings. The number of retail clinic locations across the United States rose from 1,183 in 2010 to 1,866 in 2015. 3 3. Hiroko Tabuchi, "How CVS quit smoking and grew into a health care giant," the New York Times , July 11, 2015, nytimes.com. CVS, which operates about half of the retail clinics, has announced that it plans to have 1,500 clinics by 2017. Growth among other the major players is likely to accelerate now that Walmart is putting primary care practices within its stores, and Walgreens is partnering with Theranos to offer convenient, affordable blood testing.

Only young people are using technology to manage their health and healthcare needs.

In both this year’s and last year’s CHI surveys, we also asked participants about using technology to manage their health and healthcare needs. Not surprisingly, millennials (those between the ages of 18 and 34) were more likely to report using technology for these purposes, but a considerable number of the older participants were doing so as well (Exhibit 7). In all age groups, the top two activities were communicating with doctors and scheduling appointments. However, millennials were much more likely than older participants were to say that they were using social media to share wellness ideas and participate in online wellness groups.

We also asked participants about whether they had used website or apps for a number of health-related activities, and, if so, whether they thought those resources were more or less effective than phone or in-person communication. For two of the most common activities—communicating with a physician and scheduling appointments—the majority of participants age 65 and older (65% and 78%, respectively) thought that websites and apps were more effective.

Most people are willing to trust insurers to store their health records.

In our 2014 CHI survey, we asked the participants to imagine having some sort of health monitoring device. We then asked them two questions: Where would they be comfortable storing information from that device? And with whom would they be willing to share the data?

Apropos storage, the participants overwhelmingly chose PCPs (Exhibit 8). Only a minority of them said they were comfortable having health insurers, Google, or Apple store their health data, and even fewer people chose employers. Participants also named PCPs as the group with whom they were most comfortable sharing the data (Exhibit 8). In both cases, age had only a small impact on the answers received.

We believe that healthcare consumerism will soon enter the steep slope of the innovation S curve and become a much more significant force. Payors and providers need to begin making plans now if they want to be ready to respond to, and perhaps shape the evolution of, healthcare consumerism.

The data and insights we have amassed can help them do that. Our findings suggest, for example, that payors should think about what value proposition they want to offer to consumers. That value proposition can be, but doesn’t have to be, price related—consumers are open to other enticements. And payors should not assume they are the natural owners of consumers’ health records; they will have to find a way to earn greater consumer trust if they want to do that. Providers should not take patient loyalty for granted or underestimate the role that experience-related factors such as convenience and empathy play in consumer satisfaction and loyalty.

The results described in this article are only a fraction of the information we have amassed. Our findings also reveal important attitudinal differences based on age, gender, ethnicity, income, health status, and geography—differences that have important implications for both payors and providers. These findings have convinced us that both payors and providers need to better understand what really drives consumer decision making and focus on that (rather than just on what consumers say). This understanding must be based on very granular data to ensure its relevance to local healthcare players.

In addition, both payors and providers should think about the evolving role of new healthcare technologies in shaping consumer behaviors so they can take advantage—and not become victims—of them. Perhaps most important, both payors and providers should realize that consumers’ expectations are no different in healthcare than in any other industry. In fact, other industries will continue to shape these expectations—healthcare companies need to catch up, or they risk being disrupted.

Jenny Cordina is a principal in McKinsey’s Detroit office, Rohit Kumar is an associate principal in the Chicago office, and Christa Moss is a consultant in the Cleveland office.

The authors would like to thank Erica Coe, Elizabeth Jones, Katherine Linzer, Elina Onitskansky, Kyle Weber, and Emir Roach for their contributions to this article.

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