Qualitative study on influencing factors of acceptance of advance care planning in patients with end-stage heart failure based on COM-B theory.

With the advent of the digital health era, the internet has become the most convenient channel for the public to access health-related information (). According to the 57th Statistical Report on China's Internet Development, released by the China Internet Network Information Center (), as of December 2025, the number of internet users in China had reached 1.125 billion, and the internet penetration rate had reached 80.1%. The widespread practice of seeking online health information has led individuals, when experiencing discomfort, to prioritize searching for disease information related to their symptoms through search engines rather than directly seeking professional medical help. Previous research has identified a “symptom escalation” phenomenon in this behavior: individuals conducting searches tend to associate common, potentially benign symptoms with descriptions of more severe illnesses. As they search for information, their health concerns gradually intensify (). Moreover, given the characteristics of online health information—such as diverse sources, uneven quality, and lack of professional review—the public is more likely to develop cognitive biases when accessing and evaluating such information, which may in turn be associated with the onset or elevation of cyberchondria. Cyberchondria refers to a condition where individuals, driven by anxiety and distress regarding their own health, conduct excessive or repeated online searches for health-related information. This behavior paradoxically amplifies their anxiety or distress, leading to heightened stress, excessive worry, and unnecessary medical expenditures (, ). Subsequently, scholars have continued to deepen their understanding of cyberchondria: McElroy and Shevlin () developed the Cyberchondria Severity Scale, operationalizing it as a measurable and multidimensional construct. Fergus () further confirmed the unique association between cyberchondria and health anxiety, noting that cyberchondria is not merely an extension of health anxiety but possesses distinct psychological and behavioral characteristics. Cyberchondria is now recognized as an increasingly prominent global mental health concern. Research indicates that approximately 75% of people worldwide search the internet for health-related information concerning their own health (). A cross-sectional survey among Chinese university students found that 57.6% exhibited symptoms of cyberchondria (), suggesting that the prevalence of cyberchondria among young populations warrants serious attention. When examining the mechanisms underlying the development of cyberchondria, health anxiety is considered a core proximal driver (). Health anxiety refers to a psychological state characterized by excessive worry and fear about one's own health status, involving heightened attention to bodily sensations, catastrophic misinterpretation of illness-related information, and a recurrent need for reassurance (). Muse et al. () found that health anxiety significantly predicts both the frequency and duration of online health information seeking, particularly among individuals with poor health information discrimination skills. Santoro et al. () further confirmed that health anxiety mediates the relationship between somatic symptoms and cyberchondria, suggesting its critical role in the onset and maintenance of cyberchondria.