Associations and Pathways Between Online Health Information–Seeking Behavior and Patient Adherence: Cross-Sectional Study

Background: The widespread adoption of the internet has established online health information–seeking behavior (OHISB) as a primary channel for public health knowledge acquisition, potentially influencing patient adherence behaviors and physician-patient dynamics. However, the underlying pathways, particularly the role of physician-patient communication efficacy and the differential impact of various digital platforms, remain underexplored, especially among rural populations. Objective: This study examined the association between OHISB and patient adherence among rural residents in China, with a specific focus on the mediating role of physician-patient communication efficacy and the moderating roles of different platform types. Methods: A cross-sectional survey was conducted from June 2023 to October 2024 using multistage stratified sampling across 6 Chinese provinces. Participants were rural residents aged 18 to 70 years with recent health care experiences. Data from 7004 valid questionnaires were analyzed. A fixed-effects model assessed the primary association, with robustness checked via least absolute shrinkage and selection operator regression. Mediation analysis using the bootstrap method examined the indirect association through physician-patient communication efficacy, and interaction terms tested the moderating effects of platform type (internet hospitals, professional platforms, WeChat accounts, short video apps, and search engines). Results: OHISB showed a significant positive direct association with patient adherence (β=0.260; <.001). Physician-patient communication efficacy exhibited a significant negative indirect association with patient adherence (β=–0.026; <.001), accounting for 9.29% of the total association. Platform type significantly moderated this association: internet hospitals (β=0.099; =.04), professional platforms (β=0.081; =.04), and WeChat accounts (β=0.032; =.03) enhanced the positive association between OHISB and patient adherence, whereas short video platforms (β=–0.034; =.006) and search engines (β=–0.204; <.001) weakened it. Conclusions: Online health information seeking among rural residents was directly associated with better patient adherence, but this benefit was partially attenuated by a negative indirect association through reduced physician-patient communication efficacy. The association between OHISB and adherence varied significantly by platform type. This finding suggests the need for digital health equity strategies, interventions to improve communication efficacy and health literacy, and graded management of health information platforms.