Health Communication

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Believing in Expertise: How Authors’ Credentials

and Language Use Influence the Credibility of
Online Health Information

Franziska M. Thon & Regina Jucks

To cite this article: Franziska M. Thon & Regina Jucks (2017) Believing in Expertise: How Authors’
Credentials and Language Use Influence the Credibility of Online Health Information, Health
Communication, 32:7, 828-836, DOI: 10.1080/10410236.2016.1172296

To link to this article: https://doi.org/10.1080/10410236.2016.1172296

Published online: 28 Jul 2016.

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HEALTH COMMUNICATION
2017, VOL. 32, NO. 7, 828–836
http://dx.doi.org/10.1080/10410236.2016.1172296

Believing in Expertise: How Authors’ Credentials and Language Use Influence the
Credibility of Online Health Information
Franziska M. Thon and Regina Jucks
Institute of Psychology for Education, University of Muenster

ABSTRACT
Today, many people use the Internet to seek health advice. This study examines how an author’s
expertise is established and how this affects the credibility of his or her online health information. In
a 2 (authors’ credentials: medical vs. nonmedical) × 2 (authors’ language use: technical vs. every day)
within-subjects design, 127 study participants, or “seekers,” judged authors’ expertise, benevolence, and
integrity as well as the credibility of their medical statements. In addition, we assessed seekers’
awareness of their own knowledge and behavior. Results revealed that users consciously rewarded
authors’ credentials and subconsciously punished technical language. Seekers were keenly aware of
authors’ credentials and perceived authors with medical credentials to have a higher level of expertise
and their information to be more credible. Technical language use negatively affected authors’ integrity
and the credibility of their health information, despite seekers being unaware of it. Practical implications
for health communication and implications for future research are outlined.

Introduction can be determined absolutely (e.g., 10 years of special train-

ing) or relatively (e.g., in contrast to laypersons) and refers
The Internet has become a curator of knowledge and a
primarily to top performance (e.g., athletes) or professional
bastion of shared experiences. More than 70% of adults
knowledge (e.g., academic professionals). Nowadays, anyone
rely on the Internet to acquire health information (Fox &
can accumulate a substantial amount of knowledge in the
Duggan, 2013) and solve health-related problems (see
medical field using the Internet (informed patients, Kivits,
Higgins, Sixsmith, Barry, & Domegan, 2011 for a literature
2004). However, the expertise that laypersons can establish
review). Easily available health information on the Internet
significantly differs from that of experts (for the limits of lay
can empower people (e.g., Bass et al., 2006). However, gate-
expertise in medicine, see Prior, 2003). Experts’ knowledge is
keeping mechanisms are often absent, and misinformation
not only deeper, but also differently structured (e.g., Bromme
spreads easily (Lewandowsky, Ecker, Seifert, Schwarz, &
& Jucks, 2001). It is more and more difficult for an individual
Cook, 2012; Metzger, Flanagin, & Zwarun, 2003). As a
to gain in-depth knowledge in more than one area, because
result, seekers of health information (hereinafter referred
knowledge areas are highly complex (Keil, 2010). The increas-
to as “seekers”) need to be wary as to who and what health
ing specialization of knowledge is leading to a greater division
information they trust.
of cognitive labor (see Bromme, Kienhues, & Porsch, 2010;
Trust is defined as the “willingness to be vulnerable to the
Keil, Stein, Webb, Billings, & Rozenblit, 2008). Consequently,
actions of another party” (Mayer, Davis, & Schoorman, 1995,
“people stay laypersons throughout their life regarding most
p. 712) and is the result of the advisor’s perceived trustworthi-
knowledge domains including domains that vitally affect their
ness and seekers’ own propensity to trust. When reading
private and civic life (e.g., health-related questions)” (Bromme
health information, seekers must assess the trustworthiness
& Thomm, 2016, p. 242). This bounded understanding
of their advisors, that is, the ability, benevolence, and integrity
(Bromme & Goldman, 2014) drives laypersons to seek health
of the advisor to provide credible health information (Mayer
advice from others online. Whether an advice giver is con-
et al., 1995). We focus on supposed expertise suggesting
sidered a trustworthy source of health information depends
ability as the determinative factor for trustworthiness in
on the assumption about their specialized knowledge and
online health communication (see also Toma & D’Angelo,
their pertinence for the respective area (e.g., medicine vs.
2015).
architecture; see Bromme & Thomm, 2016; Porsch &
We define expertise as a “group of skills, competencies, and
Bromme, 2010). However, in online health communication,
characteristics that enable a party to have influence within
expertise may be displayed and perceived in various ways.
some specific domain” (Mayer et al., 1995, p. 717). Expertise

CONTACT Franziska M. Thon f.thon@uni-muenster.de University of Muenster, Institute of Psychology for Education, Fliednerstraße 21, 48149 Muenster,
Germany.
© 2017 Taylor & Francis

How Seekers Perceive Authors’ Expertise in Online Health
Communication
Credentials as a Cue of Expertise
Authors’ expertise can be established through their creden-
tials. Expertise can be based on occupation, position, or
experience. Credentials, such as MD for medical doctors,
confirm qualification in a specialized area. Previous studies
in online health communication have examined credentials as
signs of expertise based on content analyses of existing online
information (e.g., Buis & Carpenter, 2009) or by comparing
professional sources with sources not providing any informa-
tion on their professional background (e.g., Hu & Sundar,
2010). There is little research on whether seekers regard
credentials as a means to determine an author’s area of
expertise for providing health information.
RQ 1a: Do author credentials conveying a medical qualifica-
tion positively affect perceived expertise of the author?
Language as a Cue of Expertise
Authors’ expertise can be established through their language use.
Language cues can be highly valid for judging expertise, because
they are hard to manipulate (see Donath, 1999). In a study
investigating online health-related communication, Toma and
D’Angelo (2015) found that long words helped participants in
distinguishing laypersons from experts. The authors argue that
long words demonstrate a sophisticated vocabulary and there-
fore indicate expertise. Although these cues mark cognitive
complexity and suggest a high level of education, they do not
provide information on specific expertise. In the current study,
we therefore focus on the technical language used by medical
professionals. Medical terms in the German language can be
expressed using everyday language (e.g., heart attack/
Herzanfall) and technical language originating from Greek or
Latin (e.g., myocardial infarction/Myokardinfarkt, see Jucks &
Paus, 2012). Both expressions are technical in that they are
“meaningful entities needed to perform a task in the area of
expertise” (Bromme, 1996, p. 184, translated). However, techni-
cal terminology may hint at more elaborate and differently
structured knowledge (Jucks & Bromme, 2007; Jucks & Paus,
2012). Consequently, laypersons may not only perceive technical
terms as more difficult (Paus & Jucks, 2011), but also attribute
their use to the high medical expertise of the author.
RQ 1b: Does the use of technical language lead to higher
perceived expertise of the author?
So far, we have discussed how an author’s credentials and
language use can influence seekers’ determination of the author’s
expertise. These cues are important when seekers draw on them
to decide whether the author’s information is credible or not.
How Seekers Perceive the Credibility of Online Health
Information
Judging the credibility of online health information is one of
the most difficult tasks for laypeople (HLS-EU Consortium,
HEALTH COMMUNICATION 829
2012). Credibility can be defined as trust in the correctness of
information (Matthes & Kohring, 2003). An author’s expertise
is thereby one aspect that may positively affect this judgment.
Various studies show a link between author credentials and
higher credibility (e.g., Fogg et al., 2001; Sillence, Briggs,
Fishwick, & Harris, 2004). Though, studies were based on
self-reports by the seekers and focused only on the presence
or absence of information about author expertise. The current
study expands upon previous research by experimentally
examining the effect of different levels of expertise on cred-
ibility. Compared with most studies on credibility focusing on
credentials only, we have added language as a second cue.
Numerous studies have shown that language has crucial
effects on the credibility of a message (e.g., Blankenship &
Holtgraves, 2005). Investigating both cues of expertise at once
will give important insights into their interplay on how health
information is perceived online.
Language affects credibility depending on the author’s
credentials. Credentials might be more salient and lead to
the expectation of a specific language use. Language expec-
tancy theory (Burgoon & Miller, 1985) describes how a source
can raise expectations toward a specific language use and
thereby influence judgments of its credibility. People had
“relatively rigid normative expectations of what was ‘appro-
priate’ or expected communication behavior. Such expecta-
tions were not unique to specific communicators, but to
aggregates of like individuals” (Burgoon, Denning, &
Roberts, 2002, p. 122). Depending on their social grouping,
people are ascribed a bandwidth of expected and therefore
adequate communication behavior. Privileged groups have a
broader range of expected language use (Burgoon et al., 2002).
Applying the theory to our study, authors’ credentials suggest-
ing that someone is from a privileged group (i.e., a medical
expert) should grant the author a greater bandwidth of ade-
quate language use (i.e., technical as well as everyday lan-
guage). Authors with nonmedical credentials, by contrast,
should be granted a smaller range of expected language use
and be perceived as more credible when using everyday lan-
guage adequate for their level of expertise.
RQ 2a: Do seekers judge health information by medical experts
as credible irrespective of the specific language used?
RQ 2b: Do seekers judge health information provided by non-
medical experts as more credible when using everyday
language?
The Role of Meta-Cognitive Judgments in Online Health
Communication
To successfully acquire health information online, seekers
must activate meta-cognitive processes regarding their own
knowledge and behavior (Mason & Boldrin, 2008). That is,
they need to be aware of how well they know a specific topic
(see meta-cognitive calibration, Pieschl, 2009) and monitor
their search process in order to self-regulate knowledge acqui-
sition in health communication (see Brown, 1978; Flavell,
1979). The skill to accurately assess one’s own knowledge
830 F. M. THON AND R. JUCKS
and behavior is part of health-related self-management and
feeds into the established parameters of successful online
health communication (see Sørensen et al., 2012). Hence,
seekers need to judge not only the credibility of the health
information encountered (“Is this correct information?”), but
also their own knowledge (“How certain am I that this infor-
mation is correct?”) and monitor their seeking behavior
(“What information do I base my judgment on?”). This is
especially relevant when seekers encounter potentially erro-
neous information.
Seekers’ Judgments Regarding Their Knowledge
In order to assess people’s accuracy regarding their own
knowledge, we need to examine seekers’ actual knowledge
(correctness of their credibility judgments) and compare it
with seekers’ judgment of their knowledge (certainty of their
own knowledge). Seekers accurately judge their own knowl-
edge if they are more certain when they judge health informa-
tion correctly and less certain when they are wrong (see
Pieschl, 2009).
RQ 3: Does seekers’ correctness of credibility judgment match
their level of certainty?
However, our manipulation of language use may interfere
with these judgments. Everyday language may enhance see-
kers’ perceived familiarity and access to their own knowledge
(seduction of easiness, Scharrer, Bromme, Britt, & Stadtler,
2012) and therefore affect not only their correctness when
judging the credibility of health information, but also their
certainty when doing so. This may be the case, even if seekers
are able to encode only parts of the medical term (e.g., “high,”
“blood,” and “pressure”; see Jucks & Paus, 2012). Therefore,
seekers may be more accurate and feel more certain when
judging health information conveyed in everyday language.
RQ 4: Does everyday language positively influence seekers’
certainty in and correctness of their credibility judgments?
Seekers’ Judgments Regarding Their Seeking Behavior
Seekers need to monitor not only their own knowledge, but
also their seeking behavior. Awareness about how one comes
to a credibility judgment is an important requirement for
successful knowledge acquisition. Thus, an additional aim of
this research is to assess seekers’ meta-cognitive judgments
regarding the information they believe they have based their
credibility judgment on (stated basis) and compare it with the
information they actually based their judgments on (actual
basis).
RQ 5: To what extent does seekers’ actual basis match the
stated basis for their judgment?
While the ability to find accurate information is of impor-
tance for seekers, establishing credibility is an important skill
for scholars in health communication (Hannawa et al., 2014).
The current paper advances the understanding of the factors
affecting the establishment of credibility in interpersonal
online health communication. We investigate our research
questions in the context of online health forums, because
they are frequently used for locating health information and
for their strong influence on seekers’ behavioral intentions
(Hu & Sundar, 2010). We focused on young and well-edu-
cated people as they most frequently seek health information
online (Andreassen et al., 2007; Fox & Duggan, 2013).
Method
Participants
The predominantly student participants were recruited online
via the faculty e-mailing lists and social network groups at a
large German university and were reimbursed with a 10€
Internet shop voucher. Only data from participants who com-
pleted the online experiment were analyzed. In total, 11 par-
ticipants were excluded: 4 participants took one or several
longer breaks during the experiment (M = 2.9 h,
SD = 2.6 h); 5 were using external research sources (despite
being instructed not to do so); 1 person did not speak suffi-
cient German; and 1 person had technical problems. In total,
we analyzed data from 127 participants (78 females, 49 males)
aged 18 to 53 years (M = 22.64, SD = 4.59). All participants
were native German speakers and well educated. The highest
academic qualifications achieved were PhD (2%), master
(6%), bachelor (15%), university-entrance diploma (76%),
and secondary education diploma (2%). Participants were
from various disciplines, namely, cultural studies (29%), nat-
ural sciences and engineering (26%), economics (16%), law
(11%), educational science (10%), and health sciences (11%,
including nine participants specialized in the field of
medicine).
Design and Material
We manipulated authors’ expertise for medical statements in
a 2 (credentials: medical experts vs. experts from a nonme-
dical area) × 2 (language: technical vs. every day) within-
subjects design. We created a total of 30 statements, one-half
of which were true and one-half of which were false (see
Appendix A). The statements and their classification as true
or false represented the well-established knowledge in the
medical field. We conveyed the experimental manipulation
of the author’s credentials through academic title and the
area of expertise (e.g., “doctor of medicine, orthopedic” vs.
“master of science, paleontologist”). We chose surnames
drawn from a list of the 40 most common German sur-
names. No forenames were mentioned to avoid gendering.
Language was manipulated through word origin. Everyday
language referred to German language (e.g., heart attack/
Herzanfall), and technical language stemmed from Latin or
Greek (e.g., myocardial infarction/Myokardinfarkt). Note
that, according to the entries in medical dictionaries, all
manipulated words used medical terminology despite their
origin. The length of statements ranged between 6 and 18
words (M = 11.10, SD = 2.51).

Procedure
The experiment was performed using Enterprise Feedback
Suite (EFS) Survey© (online survey software) and lasted
approximately 30 min (M = 31.88 min, SD = 15.45 min).
Participants were informed that they were taking part in a
study on health communication and would receive health-
related statements as posted in online forums. In the first
part of the study, participants received 20 statements in a
randomized order and were asked to judge the credibility of
each statement and to estimate certainty regarding their own
decisions. We then asked participants to write about how they
made their credibility judgments.
To investigate whether an author’s credentials and lan-
guage are used as cues of expertise, we used 10 new state-
ments in the second part of the study. This time we asked
participants to rate the authors’ expertise as well as their
benevolence and integrity to get a comprehensive understand-
ing of all three factors of trustworthiness. Moreover, we
implemented a manipulation check for language, asking par-
ticipants to rate the difficulty of several medical terms.
In the third part of the study, participants indicated their
own propensity to trust and their personal demographic data.
To avoid medical misconceptions, participants were debriefed
and requested to carefully read corrected versions of the
medical statements. Participants could enter their e-mail
address to receive reimbursement (this information was
saved separately from experimental data and deleted after
reimbursement). On the final page, participants were thanked
and dismissed.
Dependent Variables
Authors’ Trustworthiness
We applied the Muenster Epistemic Trustworthiness
Inventory (METI; Hendriks, Kienhues, & Bromme, 2015) to
assess perceived expertise of the author. In addition, we
assessed their benevolence and integrity to get the full picture
on how authors are perceived. Fifteen items rated expertise
(e.g., “qualified/unqualified,” Cronbach’s α = 0.90), benevo-
lence (e.g., “considerate/inconsiderate,” Cronbach’s α = 0.97),
and integrity (e.g., “honest/dishonest,” Cronbach’s α = 0.92).
All items were rated on 7-point scales ranging from 1 (very
trustworthy) to 7 (not trustworthy at all).
Credibility of Health Statements
We deployed two measures of credibility in the study. On the
one hand, participants were asked very directly to indicate
whether the statement was true or false. Based on participants’
responses to all 20 statements, we analyzed the proportion of
statements each participant rated as true in each of the four
conditions from our 2 × 2 within-subjects design. On the
other hand, we asked participants to more indirectly judge
the credibility on four items regarding “trust in the correct-
ness of information” (Matthes & Kohring, 2003). This mea-
sure was developed in journalism research, but may provide
additional insights due to the more detailed assessment of
credibility on a Likert scale. Items (e.g., “The statement
reflects things, as they are,” Cronbach’s α = 0.93) were rated
HEALTH COMMUNICATION 831
on 5-point scales ranging from 1 (strongly disagree) to 5
(strongly agree). The direct and indirect measures of credibil-
ity correlated significantly, r(127) ≥ 0.47, p ≤ 0.001. Due to the
small effect sizes, we will analyze both measures separately.
Correctness of Health Statements
As half of the statements were true and half were false, we
analyzed the proportion of correct judgments in each of the
four conditions.
Certainty in Credibility Judgment
We asked participants to state how certain they were regard-
ing their credibility judgment on a 7-point scale ranging from
1 (very certain) to 7 (very uncertain).
Belief about Credibility Judgment
Participants were asked in an open format to report how they
made their credibility judgment. The coding scheme was
developed based on the answers provided. Overall, answers
occurred in three main categories: decision-making due to the
author’s credentials, the technicality of language used, and
prior knowledge. Inter-rater reliability was sufficiently high
in all three categories (0.64 ≤ Cohen’s κ ≥ 0.95).
Manipulation Check
Difficulty of Language
Participants were asked to rate the difficulty of the medical
language. Five items addressed the aspects of perceived tech-
nicality, complexity, and comprehensibility. However, internal
consistency was below the accepted standards (Cronbach’s
α = 0.64), thus, we refrain from reporting the collected data.
Control Measures
Propensity to Trust
As mentioned in the introduction, trust is influenced not only
by the expertise of a source, but by people’s own propensity to
trust others. Eight items from the revised NEO (Neuroticism,
Extraversion, Openness) personality inventory of the subscale
trust (NEO-PI-R: Ostendorf & Angleitner, 2004; see also
Costa & McCrae, 1992) were implemented to assess partici-
pants’ propensity to trust (e.g., “I believe that most people
generally have good intentions,” Cronbach’s α = 0.85) on 5-
point scales ranging from 1 (strongly disagree) to 5 (strongly
agree). Individual scores ranged from 1.38 to 4.88 with an
average of M = 3.40 (SD = 0.68). Correlations between pro-
pensity to trust and the main dependent measures were not
significant: credibility, r(127) = 0.05, p = 0.57; correctness, r
(127) = −0.02, p = 0.83; and certainty, r(127) = 0.004, p = 0.97.
Hence, propensity to trust was dropped from further analyses.
Medical Knowledge
Participants were asked to indicate their medical knowledge on a
scale from 1 (bad) to 5 (good). On average, participants rated their
prior medical knowledge as “medium” (M = 2.81, SD = 1.0).
While some participants rated their medical knowledge as “good”
(9%) or “rather good” (10%), most participants rated it as “med-
ium” (36%) or “rather bad” (40%). Only 4% of the participants
832 F. M. THON AND R. JUCKS

rated their medical knowledge to be “bad.” These data are also

reflected by the sample characteristics including both people with
and without medical training. Thus, we believe that our sample is
heterogeneous with regard to medical knowledge and training,
and therefore is representative of the general public.

Results
Unless indicated otherwise, we conducted 2 (credentials: med-
ical experts vs. experts from a nonmedical area) × 2 (language:
technical vs. every day) repeated measures analyses of var-
iance (ANOVA). All statistical tests were two tailed, and alpha
was set at 5% except when noted otherwise. For descriptive
results of all quantitative variables, see Appendix B. Figure 1. Percent of credible statements.

Author’s Trustworthiness of technical language, as indicated by a very large and significant

We wanted to find out whether medical credentials and the use
of technical language affect perceived author expertise (RQ
1a + 1b). The analysis for epistemic trustworthiness showed a
large and highly significant main effect of author’s credentials
on expertise, F(1, 115) = 93.02, p < 0.001, η2 = 0.45, benevolence
F(1, 115) = 162.59, p < 0.001, η2 = 0.59, and integrity, F(1,
115) = 55.72, p < 0.001, η2 = 0.33. All effects indicated that
authors with medical credentials were considered as more trust-
worthy. Furthermore, we found a medium main effect of lan-
guage on the subscale integrity, F(1, 115) = 7.45, p = 0.007,
η2 = 0.06, indicating that authors’ perceived integrity was higher
when using everyday language.
Credibility of Health Statements
We questioned how an author’s credentials and language
use influence the credibility of online health information
(RQ 2a + 2b). The analysis of the direct measure of cred-
ibility showed a large main effect of credentials, F(1,
126) = 25.75, p < 0.001, η2 = 0.17, indicating that partici-
pants found medical authors’ statements to be more credible
than statements from nonmedical authors. We further
found a significant main effect of language, F(1,
126) = 8.35, p = 0.01, η2 = 0.06. However, this main effect
was due to the significant disordinal interaction between
credentials and language, F(1, 126) = 7.96, p = 0.01,
η2 = 0.06. Authors with nonmedical credentials were per-
ceived as more credible when using everyday language, t
(126) = 3.7, p < 0.001, whereas language did not affect the
credibility of medical authors (see Figure 1). On the indirect
measure of credibility, we found the same large main effect
of credentials, F(1, 126) = 52.52, p < 0.001, η2 = 0.29, as well
as a large main effect of language, F(1, 126) = 47.73,
p < 0.001, η2 = 0.28, indicating that statements with every-
day language were believed to be more correct. No interac-
tion was found, F(1, 126) = 1.35, p = 0.25.
main effect of language, F(1, 126) = 46.01, p < 0.001, η2 = 0.27.
No further effects were found, all F(1, 126) ≤ 1.66, p ≥ 0.20.
Overall, the percentage of participants correctly judging the
medical statements ranged from 25% to 94% per item.
Certainty in Credibility Judgment
We examined whether everyday language affected participants’
certainty in their own decision (RQ 4). The analysis showed that
participants were more certain in their judgment when state-
ments used everyday language, as indicated by a very large and
highly significant main effect of language, F(1, 126) = 266.17,
p < 0.001, η2 = 0.68. Interestingly, we also found a significant
medium main effect of credentials, F(1, 126) = 10.73, p = 0.001,
η2 = 0.08, indicating that participants were more certain when
the author had medical credentials. No interaction was found, F
(1, 126) = 1.02, p = 0.31 (see Figure 2).
In addition, we analyzed whether participants’ certainty
matched the correctness of their answers (RQ 3). Therefore,
we compared certainty for correct and incorrect answers.
Overall, we found that certainty for correct answers was sig-
nificantly higher (M = 3.27, SD = 0.67) than for incorrect
answers (M = 2.72, SD = 0.72), t(108) = 8.79, p < 0.001. To
determine whether the matching was affected by our manip-

Correctness of Health Statements

We questioned whether everyday language affected participants’
correctness (RQ 4). Participants were better at detecting whether
a statement was true when everyday language was used instead Figure 2. Certainty of credibility judgments.

ulation, we conducted separate 2 × 2 repeated measures
analyses for both correct and incorrect responses. Note that
the datasets for the following analyses were smaller, because
participants had to have at least one correct answer and one
incorrect answer in each of the four conditions in order to be
included in the data analysis. Both analyses of trust for cor-
rectly and incorrectly answered items showed a highly signif-
icant main effect of language, F(1, 113) = 132.35 p < 0.001,
η2 = 0.54 and F(1, 49) = 75.37, p < 0.001, η2 = 0.61.
Furthermore, we found a significant main effect of credentials
for correct answers, F(1, 113) = 4.73 p = 0.03, η2 = 0.04, and
incorrect answers, F(1, 49) = 9.64, p < 0.01, η2 = 0.16. The
interaction between language and credentials did not attain
significance in the analysis of either correct or incorrect
answers, F(1, 113) = 0.05, p = 0.82 and F(1, 49) = 3.4,
p = 0.07, respectively.
Belief about Credibility Judgment
When asked how participants had reached their decision, 82%
of participants stated that their prior knowledge had influ-
enced their decision-making. Sixty-five percent mentioned the
author’s credentials. Among these, 39% reported that state-
ments from authors with medical credentials were more cred-
ible. By contrast, only 12% of the participants mentioned that
the technicality of language played a role in their decision-
making. However, only two participants stated a positive link
between technical language and credibility, while the remain-
ing participants linked language to their own knowledge. That
is, they perceived technical words to be harder to understand,
leading to greater insecurity in their judgments.
Matching of Belief and Actual Basis for Judgment
We asked to what extent the seekers’ own-stated basis for
credibility judgment matches the actual basis for their judgment
(RQ 5). A 2 × 2 repeated measures analysis including only
participants who mentioned having used credentials showed a
significant main effect of credentials on credibility, F(1,
67) = 53.92, p ≤ 0.001, η2 = 0.45, as well as a significant main
effect of language, F(1, 67) = 4.27, p = 0.04, η2 = 0.06, and a
significant interaction, F(1, 67) = 5.91, p = 0.02, η2 = 0.08. All
effects indicate the same direction as those including all parti-
cipants. By contrast, the analysis of participants who did not
mention credentials as a criterion for credibility judgment
revealed that their credibility judgments did not differ signifi-
cantly in relation to author credentials, F(1, 58) = 0.08, p = 0.78.
However, we did find a significant main effect of language
pointing in the same direction, F(1, 58) = 4.03, p = 0.049,
η2 = 0.07. No interaction was found, F(1, 58) = 2.36, p = 0.13.
Discussion
In this paper, we examined people’s perceptions of expertise
and credibility when seeking online health information.
Drawing on the concept of the cognitive division of labor,
we outlined that seekers are highly dependent on expert
advice. We proposed that credentials and language use could
HEALTH COMMUNICATION 833
be signs of expertise that can help seekers determine cred-
ibility in online health communication.
Cues of Expertise in Online Health Communication
An author’s credentials are an important cue of expertise in online
health communication. As expected (RQ 1a), seekers perceived a
medical expert as having a greater expertise to give health-related
insights. Interestingly, medical experts were also perceived as
having higher benevolence and integrity. This positive effect
may be due to physician’s requirement to take the Hippocratic
oath. These results demonstrate that laypeople place high levels of
trust in traditional cues, as is true in the offline world. However, as
the famous quote says: “On the Internet, nobody knows that
you’re a dog” (Steiner, 1993). Anybody can call himself an expert
in an online environment. Thus, unverified credentials may be
misleading. Based on our results, we strongly recommend that
online health information websites should make source cues
salient and, if possible, verifiable. Future research should focus
strongly on the difficult prospect of social verification in online
health forums, where control from authorities is impractical.
Contrary to our expectations (RQ 1b), technical language did
not affect the perception of the author’s expertise. While seekers
might use complex language to distinguish health advice from
experts and laypersons (Toma & D’Angelo, 2015), the results of
our study suggest that the use of technical language in itself will
not help authors establish themselves as experts in online health
communication. Instead, the results of our study show that
comprehensibility is key. Authors using everyday language
were perceived as having higher integrity. Integrity refers to
being sincere, honest, just, or fair (see Mayer et al., 1995).
Authors can be fair only if the audience is able to understand
their information (see also Clark & Murphy, 1982; Fussell &
Krauss, 1989). Similarly, terming the positive effect of compre-
hensible language the “seduction of easiness,” Scharrer et al.
(2012) emphasized that people’s ability to comprehend informa-
tion will affect their judgment. This leads us to the question of
how authors’ credentials and language use affected the credibility
of their health information.
The Credibility of Health Information: An Interaction of
Cues
Seekers strongly believe health information provided by
experts. Our results showed that seekers judged health infor-
mation as more credible when provided by an author with
medical credentials. As expected (RQ 2a), medical experts
were granted a greater range of acceptable communication
behavior. That is, their health information was judged as
credible, regardless of the technicality of language they used.
By contrast, health information from nonmedical experts was
more credible when the authors used everyday language (RQ
2b). These results are in line with the theory of language
expectancy (Burgoon & Miller, 1985) in that doctors were
given license to use technical as well as everyday language.
On the other hand, authors who were not medical profes-
sionals were judged as not entitled to use technical language.
Our results suggest that experts should provide unambiguous
credentials to gain the trust of seekers, especially when using
834 F. M. THON AND R. JUCKS
technical language. Overall, the results of our study point to
the positive effect of everyday language in online health com-
munication. Everyday language not only positively affects the
author’s integrity, but also enhances the credibility of health
information. Note that the effect of everyday language on
credibility was stronger when seekers judged the credibility
on a Likert scale, compared with the dichotomous forced
choice measure. This difference may be due to providing
participants a greater range of responses when applying a
Likert scale measure.
Meta-Cognitive Judgments in Online Health
Communication
Seekers’ judgments regarding their own knowledge were fairly
accurate (RQ 3). Seekers’ correctness matched their level of
certainty, that is, they were more certain when they judged the
credibility of the health information correctly and they were
less certain when they were wrong. These results reflect that
participants accurately monitored their learning process. This
is an important requirement for successful knowledge acqui-
sition in health communication.
As expected, participants were better and more certain in
judging health information conveyed in everyday language
(RQ 4). This may reflect the ability to better access their
own knowledge. The use of everyday language makes health
information more comprehensible and enhances seekers’ abil-
ity to judge the validity of the information. Clear comprehen-
sible communication puts the seeker in the best position to
obtain necessary health information. These results may apply
to health information in other media as well. Thus, we advise
health information providers to provide easy-to-understand
health information and understandable explanations when
using technical terms.
Regarding study participants’ judgment of their own seek-
ing ability, the results of our study showed that monitoring
performance depends on the cue (RQ 5). While seekers used
authors’ credentials purposefully and knowingly to determine
health information credibility, their judgment was affected by
authors’ language use without being aware of it. In contrast to
other cues in online health communication, language use may
be less important. Our results not only emphasize the impor-
tance of language use, but also point to the need for training
seekers to monitor their own seeking behavior.
Limitations of the Current Study
Since we used clear and unambiguous cues and presented no
distractions, our study might not account for sleeper effects (see
Eagly & Chaiken, 1993). Although we presented a commonly
encountered situation, there was very little distracting informa-
tion compared with the real-world setting. Several previous stu-
dies have demonstrated that sources are not always considered or
are even forgotten later on (e.g., Eysenbach & Köhler, 2002).
These effects could be even more pronounced when people use
various online sources to seek health information.
We used two measures of credibility, which revealed
slightly different results. The direct measure forced seekers
to decide whether the given information was correct or not,
while the indirect measure gave seekers the possibility to
differentiate between levels of credibility on a scale of one to
five. Although both measures were related, the interaction
between authors’ credentials and language use was limited to
the direct measure, and therefore can reflect credibility only
under forced decision-making.
Conclusion
Health information seekers consciously viewed credentials to
infer an author’s medical expertise and to judge the credibility
of online health information. By contrast, technical language
use negatively affected authors’ integrity and the credibility of
their health information, especially for nonmedical authors.
While seekers accurately assessed their own medical knowl-
edge, which reflects that seekers monitored their learning
process, they deficiently monitored their seeking behavior
when the cue was less salient (i.e., language use). However,
the skills to accurately assess one’s knowledge and behavior
are important requirements of people’s health-related self-
management. Supporting seekers to establish successful self-
management strategies, including consciously monitoring
their seeking strategy, is an important future challenge for
health and education policy, as well as for practitioners.
Future research should focus on the subconscious impact of
language in online health communication.
Funding
This research was supported by a grant awarded to the second author
within the German Research Foundation’s (DFG) Research Training
Group GRK 1712: Trust and Communication in a Digitized World. We
thank Jonathan Harrow for language editing.
References
Andreassen, H., Bujnowska-Fedak, M., Chronaki, C., Dumitru, R.,
Pudule, I., Santana, S., & Wynn, R. (2007). European citizens’ use of
E-health services: A study of seven countries. BMC Public Health, 7,
53. doi:10.1186/1471-2458-7-53
Bass, S. B., Ruzek, S. B., Gordon, T. F., Fleisher, L., McKeown-Conn, N.,
& Moore, D. (2006). Relationship of Internet health information use
with patient behavior and self-efficacy: Experiences of newly diag-
nosed cancer patients who contact the National Cancer Institute’s
Cancer Information Service. Journal of Health Communication, 11,
219–236. doi:10.1080/10810730500526794
Blankenship, K. L., & Holtgraves, T. (2005). The role of different markers
of linguistic powerlessness in persuasion. Journal of Language & Social
Psychology, 24, 3–24. doi:10.1177/0261927X04273034
Bromme, R. (1996). Fachbegriffe [Technical terms]. In G. Strube, B.
Becker, C. Freska, U. Hahn, G. Palm, & K. Opwis (Eds.),
Wörterbuch der Kognitionswissenschaft [Dictionary of the cognitive
science] (pp. 184). Stuttgart, Germany: Klett-Cotta.
Bromme, R., & Goldman, S. R. (2014). The public’s bounded under-
standing of science. Educational Psychologist, 49, 59–69. doi:10.1080/
00461520.2014.921572
Bromme, R., & Jucks, R. (2001). Wissensdivergenz und Kommunikation:
Lernen zwischen Experten und Laien im Netz [Knowledge divergence
and communication: Learning between experts and laypersons on the
net]. In F. W. Hesse & H. F. Friedrich (Eds.), Partizipation und
Interaktion im virtuellen Seminar [Participation and interaction in
the virtual seminar] (pp. 81–103). Münster, Germany: Waxmann.
Bromme, R., Kienhues, D., & Porsch, T. (2010). Who knows what and
who can we believe? Epistemological beliefs are beliefs about

knowledge (mostly) to be attained from others. In L. D. Bendixen & F.
C. Feucht (Eds.), Personal epistemology in the classroom: Theory,
research, and implications for practice (pp. 163–193). Cambridge,
England: Cambridge University Press. doi:10.1017/
CBO9780511691904.006
Bromme, R., & Thomm, E. (2016). Knowing who knows: Laypersons’
capabilities to judge experts’ pertinence for science topics. Cognitive
Science, 40, 241–252. doi:10.1111/cogs.12252
Brown, A. L. (1978). Knowing when, where, and how to remember: A
problem of metacognition. In R. Glaser (Ed.), Advances in instruc-
tional psychology (Vol. 1, pp. 77–165). Hillsdale, NJ: Lawrence
Erlbaum.
Buis, L. R., & Carpenter, S. (2009). Health and medical blog content and
its relationships with blogger credentials and blog host. Health
Communication, 24, 703–710. doi:10.1080/10410230903264014
Burgoon, M., Denning, V. P., & Roberts, L. (2002). Language expectancy
theory. In J. P. Dillard & M. Pfau (Eds.), The persuasion handbook:
Developments in theory and practice (pp. 117–136). Thousand Oaks,
CA: Sage.
Burgoon, M., & Miller, G. R. (1985). An expectancy interpretation of
language and persuasion. In H. Giles & R. Clair (Eds.), The social and
psychological contexts of language (pp. 199–229). London, England:
Erlbaum.
Clark, H. H., & Murphy, G. L. (1982). Audience design in meaning and
reference. Advances in Psychology, 9, 287–299.
Costa, Jr., P. T., & McCrae, R. R. (1992). Revised NEO personality
inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) pro-
fessional manual. Odessa, FL: Psychological Assessment Resources.
Donath, J. S. (1999). Identity and deception in the virtual community. In
M. A. Smith, P. Kollock, & I. Heywood (Eds.), Communities in cyber-
space (pp. 29–59). London, England: Taylor & Francis.
Eagly, A. H., & Chaiken, S. (1993). The psychology of attitudes. Fort
Worth, TX: Harcourt Brace Jovanovich.
Eysenbach, G., & Köhler, C. (2002). How do consumers search for and
appraise health information on the World Wide Web? Qualitative
study using focus groups, usability tests, and in-depth interviews.
British Medical Journal, 324, 573–577. doi:10.1136/bmj.324.7337.573
Flavell, J. H. (1979). Metacognition and cognitive monitoring: A new
area of cognitive-developmental inquiry. American Psychologist, 34,
906–911. doi:10.1037/0003-066X.34.10.906
Fogg, B. J., Marshall, J., Laraki, O., Osipovich, A., Varma, C., Fang, N., &
. . .Treinen, M. (2001). What makes web sites credible? A report on a
large quantitative study. In M. Beaudouin-Lafon & R. J. Jacob (Eds.),
Proceedings of CHI 2001 (pp. 61–66). Seattle, WA: ACM Press.
Fox, S., & Duggan, M. (2013). Health online 2013. Washington, D.C.:
Pew Research Center’s Internet & American Life Project.
Fussell, S., & Krauss, R. M. (1989). The effects of intended audience on
message production and comprehension: Reference in a common
ground framework. Journal of Experimental Social Psychology, 25,
203–219. doi:10.1016/0022-1031(89)90019-X
Hannawa, A. F., Kreps, G. L., Paek, H.-J., Schulz, P. J., Smith, S., & Street,
Jr., R. L. (2014). Emerging issues and future directions of the field of
health communication. Health Communication, 29, 955–961.
doi:10.1080/10410236.2013.814959
Hendriks, F., Kienhues, D., & Bromme, R. (2015). Measuring laypeople’s
trust in experts in a digital age: The muenster epistemic trustworthi-
ness inventory (METI). PLoS ONE, 10, e0139309. doi:10.1371/journal.
pone.0139309
Higgins, O., Sixsmith, J., Barry, M. M., & Domegan, C. (2011). A
literature review on health information-seeking behaviour on the web:
A health consumer and health professional perspective. Stockholm,
Sweden: ECDC. doi:10.2900/5788
HLS-EU Consortium. (2012). Comparative report of health literacy in
eight EU member states. The European Health Literacy Survey HLS-
EU. Retrieved from http://www.health-literacy.eu
Hu, Y., & Sundar, S. S. (2010). Effects of online health sources on
credibility and behavioral intentions. Communication Research, 37,
105–132. doi:10.1177/0093650209351512
HEALTH COMMUNICATION 835
Jucks, R., & Bromme, R. (2007). Choice of words in doctor–patient
communication: An analysis of health-related internet sites. Health
Communication, 21, 267–277. doi:10.1080/10410230701307865
Jucks, R., & Paus, E. (2012). What makes a word difficult? Insights into
the mental representation of technical terms. Metacognition &
Learning, 7, 91–111. doi:10.1007/s11409-011-9084-6
Keil, F. C. (2010). The feasibility of folk science. Cognitive Science, 34,
826–862. doi:10.1111/j.1551-6709.2010.01108.x
Keil, F. C., Stein, C., Webb, L., Billings, V. D., & Rozenblit, L. (2008).
Discerning the division of cognitive labor: An emerging understanding
of how knowledge is clustered in other minds. Cognitive Science: A
Multidisciplinary Journal, 32, 259–300. doi:10.1080/03640210701863339
Kivits, J. (2004). Researching the ‘informed patient’. Information,
Communication & Society, 7, 510–530. doi:10.1080/1369118042000305629
Lewandowsky, S., Ecker, U. K. H., Seifert, C. M., Schwarz, N., & Cook, J.
(2012). Misinformation and its correction: Continued influence and
successful debiasing. Psychological Science in the Public Interest, 13,
106–131. doi:10.1177/1529100612451018
Mason, L., & Boldrin, A. (2008). Epistemic metacognition in the context
of information searching on the web. In M. S. Khine (Ed.), Knowing,
knowledge and beliefs: Epistemological studies across diverse cultures
(pp. 377–404). New York, NY: Springer.
Matthes, J., & Kohring, M. (2003). Operationalisierung von vertrauen in
journalismus [Operationalization of trust in journalism]. Medien &
Kommunikationswissenschaft, 51, 5–23. doi:10.5771/1615-634x-2003-1-5
Mayer, R. C., Davis, J. H., & Schoorman, F. D. (1995). An integrative
model of organizational trust. Academy of Management Review, 20,
709–734. doi:10.5465/AMR.1995.9508080335
Metzger, M. J., Flanagin, A. J., & Zwarun, L. (2003). College student web
use, perceptions of information credibility, and verification behavior.
Computers & Education, 41, 271–290. doi:10.1016/s0360-1315(03)
00049-6
Ostendorf, F., & Angleitner, A. (2004). NEO-PI-R – NEO
Persönlichkeitsinventar nach Costa und McCrae - Revidierte Fassung
(PSYNDEX Tests Review) [Costa and McCrae’s revised NEO person-
ality inventory]. Göttingen, Germany: Hogrefe.
Paus, E., & Jucks, R. (2011). Depressive or just in a bad mood?
Laypersons’ assumptions about their knowledge of medical vocabu-
lary. Studies in Communication Sciences, 11, 51–70.
Pieschl, S. (2009). Metacognitive calibration - an extended conceptuali-
zation and potential applications. Metacognition & Learning, 4, 3–31.
doi:10.1007/s11409-008-9030-4
Porsch, T., & Bromme, R. (2010). Which science disciplines are perti-
nent? – Impact of epistemological beliefs on students’ choices. In K.
Gomez, L. Lyons, & J. Radinsky (Eds.), Learning in the disciplines:
Proceedings of the 9th International Conference of the Learning
Sciences (Vol. 1, pp. 636–642). Chicago, IL: International Society of
the Learning Sciences.
Prior, L. (2003). Belief, knowledge and expertise: The emergence of the
lay expert in medical sociology. Sociology of Health & Illness, 25(3),
41–57. doi:10.1111/1467-9566.00339
Scharrer, L., Bromme, R., Britt, M. A., & Stadtler, M. (2012). The seduc-
tion of easiness: How science depictions influence laypeople’s reliance
on their own evaluation of scientific information. Learning &
Instruction, 22, 231–243. doi:10.1016/j.learninstruc.2011.11.004
Sillence, E., Briggs, P., Fishwick, L., & Harris, P. (2004). Trust and
mistrust of online health sites. In Proceedings of the SIGCHI
Conference on Human Factors in Computing Systems (pp. 663–670).
New York, NY: ACM Press.
Sørensen, K., Van Den Broucke, S., Fullam, J., Doyle, G., Pelikan, J.,
Slonska, Z., & Brand, H. (2012). Health literacy and public health: A
systematic review and integration of definitions and models. BMC
Public Health, 12, 80. doi:10.1186/1471-2458-12-80
Steiner, P. (1993, July 5). On the Internet, nobody knows you’re a dog
[Cartoon]. The New Yorker, 69, 61.
Toma, C. L., & D’Angelo, J. D. (2015). Tell-tale words: Linguistic cues used
to infer the expertise of online medical advice. Journal of Language &
Social Psychology, 34, 25–45. doi:10.1177/0261927X14554484
836 F. M. THON AND R. JUCKS

Appendix A
Correct Responses for Medical Statements (Translated From German)

Correct % Correct
Items response responses
In lower back pain/lumbago, everyday movements lead to sudden pain in the upper spine. False 32
Being overweight/obesity can lead to high blood pressure and calcification of the veins and arteries of the heart. True 94
Thyroiditis can be followed by a range of different symptoms, depending on the cause. True 77
Excessive alcohol consumption can lead to high blood sugar levels/hyperglycemia. False 45
People who are heavily overweight suffer more often from breathing arrest/apnea. True 75
High blood pressure/hypertension usually causes discomfort from the very beginning and can therefore be treated at an early False 66
stage.
The most common cause for a runny nose/rhinitis is an acute cold or allergies. True 76
Headaches and pressure in the forehead and cheeks are often mistaken for symptoms of a sinus infection/sinusitis. False 44
The most common symptom of appendicitis is stomachache, especially on the left side of the lower abdomen. False 28
If gout is untreated, it can lead to kidney stones and other kidney damage. True 65
The most important part of reanimation/resuscitation is mouth-to-mouth breathing. False 61
Heart attacks/myocardial infarctions are one of the most common causes of death in industrial societies. True 69
Every stroke/cerebrovascular infarction is an emergency and needs to be treated immediately. True 80
Nose bleeding/epistaxis often results in serious medical conditions. False 69
After contagion, it usually takes only a few days before warts/verrucae develop. False 37
The cause of shingles/herpes zoster is an infection with varicella zoster virus (VZV). True 40
Middle ear inflammation/otitis media is particularly frequent in 6- to 10-year-old children. False 25
Common symptoms of an acute tonsillitis are a sore throat and difficulties in swallowing. True 87
The retina is a highly specialized layer of tissue consisting of neurons interconnected by synapses. True 82
Surgical correction of shortsightedness/myopia is usually performed with lens implants. False 58
Note. Medical language in everyday language before the slash and in technical language after the slash. Note that English does not always have an equivalent for the
German everyday expression.

Appendix B
Descriptive Results of Quantitative Variables

Experimental condition
Medical credentials Nonmedical credentials
Dependent variable Technical language Everyday language Technical language Everyday language
Credibility (of health statements)
Proportion of credible statements 0.70 (0.25) 0.71 (0.23) 0.52 (0.27) 0.64 (0.21)
Trust in the correctness of information 3.00 (0.63) 3.28 (0.71) 2.45 (0.65) 2.82 (0.69)
Correctness (of health statements) 0.53 (0.24) 0.66 (0.22) 0.55 (0.26) 0.70 (0.25)
Certainty (of credibility judgment) 2.62 (0.97) 3.67 (0.67) 2.49 (0.95) 3.45 (0.66)
Trustworthiness (of the author)
Expertise 2.94 (0.83) 2.87 (0.76) 3.79 (0.99) 3.70 (0.88)
Benevolence 2.19 (0.87) 2.29 (0.92) 4.07 (1.53) 4.24 (1.34)
Integrity 2.99 (0.84) 2.89 (0.82) 3.59 (0.92) 3.38 (0.91)